When your patient has chronic edema or lymphedema, your therapy may need to include Complete Decongestive Treatment (CDT). CDT includes manual lymphatic drainage, compression, skin care, exercises, and patient education- and is the gold standard of treatment for those with swelling issues. It, however, can come with some complications- namely, what are the best shoes I can wear when I am getting treated for lymphedema?
Complete Decongestive Therapy is an essential treatment tool that all physical and occupational therapists should have in their arsenal- to read more about the benefits of CDT, check out some of our other edema-related articles!
When it comes to the practicalities of these techniques, however, one issue that patients and therapists can both bump on a lot is – “what are the best shoes can I wear when I am going through though the ‘compression stage’ of lymphedema treatment?”. Using short stretch bandages and foam as a part of your multilayered compression wrap is widely accepted to be the best way to treat fibrosis, edema, and get great results- but it can make the foot bulkier and thus impossible to get into previously used shoes. So, what to do?
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Well, firstly- assure your patient that using short stretch bandages and foam is likely to be a relatively short-term part of their treatment. The overarching goal usually is to get the person into a compression garment that they can use long-term, which are far less bulky. Using adjustable bandages is essential for the initial phase of treatment, as the persons limb may be decongesting rapidly, as well as requiring an increased level of compression. Once the limbs have decongested to the stage where a garment can be used, they are often able to return to the footwear they were using previously. In the meantime, I suggest to my patient to get some larger, adjustable shoes that they can use during this phase pf treatment. Depending on the physical status and lifestyle demands, the person may even want more than one pair of shoes they can use- which can increase costs. Therefore, I’m including here some of the favorite shoes that I have personal experience with, don’t break the bank, and that I recommend to my patients, as well as the pros and cons of each!
1.Darco Body Armor Cast shoe
You may already be familiar with the phrase Darco shoe, which has been synonymous with a ‘cast shoe’ in medical circles. The old style of cast shoe was a flat base with straps- and essentially merely acted to save the base of the foot or cast from contact with the floor. These certainly didn’t do much for walking or support!
This new style of Darco shoe is far better, as it offers a lot of structure and support, as well as being adjustable to the size of the foot within the bandages. These have been among the best shoes our patients with lymphedema have used. I also like that this shoe has a rubberized sole for walking outdoors, and that you can order them in singular, which can work well for your patient who has unilateral edema. Right now, this shoe can be ordered for $25.99 on Amazon, or $20 on the Walmart website.
2.Top adjustable slipper
These slippers are clearly very appropriate for a bandaged foot, as they have a deep, top-sided Velcro opening that accommodates the bandages and adjusts as the bandages flattens and the foot decongests. This shoe has been reported to be very comfortable by all he patients I have had that have used it- where it comes short is on the weather- accessibility, as well as the aesthetic (depending on the age range and preferences of your client).
If your client wants to have an indoor and an outdoor shoe, this is definitely a good choice for indoor shoe, to keep the bandages clean and keep your client from slipping. I would advise a client to order these in a half size up. Right now, these slippers run $22 on Amazon.
3.Extra wide Velcro sneaker
For indoor/outdoor use, these wide sneakers are a good option, especially for your more active patients who will be covering a lot of ground, and need something supportive. These shoes have been a popular choice amongst my active clients, as they can be ordered in one size up and will accommodate the bandages well. There are several color options also, which is important- your client should feel engaged in this process as much as possible to have a sense of ownership over their wellness journey.
The main drawback to this shoe is that, although they accommodate a good amount, they are somewhat less spacious than an option like the DARCO shoe. If this is the shoe that your client selects, you may want to adjust the thickness of your bandage and use the inherent compression of the shoe to help maintain the ideal pressure level on the foot. This shoe is also far better if you are ordering shoes in winter or your live in a wetter part of the world! Currently, $39.98 on Amazon.
Diabetic shoes can be a helpful corner of the market to explore, as they typically prioritize the shoe’s ability to expand. They should also have soft material and no rough inner edges that can injure the foot (or, for our purposes, snag on the bandages). There are often a range of options to choose from, including open toe, sandal, closed, etc. When looking at diabetic shoe options for your client, however, make sure that they are adjustable enough to be able to accommodate a bulky bandage on one or both sides. If your person has unilateral edema, they should still be able to wear both shoes.
The main drawback with these shoes is that they are a bit pricier than the other options explored here. However, these may be the best shoes that your patient with lymphedema will wear even beyond the stage of treatment- which may not be able to be said for an item such as the Darco shoe! Have a look at these diabetic shoes- currently $58 on Amazon.
Working with a client with chronic edema can be a challenge, and any support and advice we can offer to make their lives easier and eliminate decision fatigue can often be very well received. I would recommend noting the best shoes that work well for your current clients with lymphedema, and keeping a list of options that they may want to consider, if the current situation is not working!
If you are interested in learning more practical tips and techniques to help manage and treat chronic swelling, be sure to check out our course, Edema Management in In-Patient Rehab, for applicable advice from a seasoned clinical problem-solver!
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