Can a woman who has diabetes wear four to five-inch high heels? You probably already know the simple answer to this question, but you are invited to a holiday party where you're sure everyone will be wearing this year's fashion -- metal heeled stilettos. Or worse, your daughter who has diabetes is invited to a formal holiday party and "all my friends have them..." "The fashion magazines say if I buy them a half size too big, they won't hurt." What to do and what to know before you make up your mind or help your daughter make up hers.

Some years ago Bonnie attended an all day medical program on type 2 diabetes. The last thing the panel moderator said was "If you have diabetic patients and you do not ask them to remove their stockings or socks, you have not done a complete physical." He added that he was concerned that this was not done routinely which was why more than 50 percent of non-traumatic amputations in the United States are linked to diabetes.

Foot lesions in diabetics are a result of peripheral neuropathy, peripheral vascular disease, infection, or more usually a combination of these. Lesions are found in feet that have become insensitive, deformed, and ischemic. This leads feet to be more susceptible to trauma which can lead to ulceration, infection, and gangrene. Early foot lesions often go undetected because they may be painless.

Warning symptoms of foot problems are dependent on the cause. Vascular symptoms include cold feet and pain at rest, especially at night. Neurological symptoms include sensations of burning, crawling, or tingling; motor weakness; inability to feel pain; and diminished sweating. Gradual changes in the foot itself can be a sign of musculoskeletal symptoms while slow healing wound, painful wounds, chronic scaling and itching, and recurrent infections are dermatologic symptoms.

The bad news is that symptoms can be absent one day and there the next. Lesions or ulcers on the feet can be caused by bacteria, trauma, continuous pressing of the skin thus cutting off blood supply, and by repeated pressure, most usually on the bottom of the feet. Without the ability to appreciate the pain these cause, the person with diabetes does not know to remove tight shoes or change his/her gait. It is easy to check for loss of protective sensation of the feet with a monofilament which is a thin plastic fiber with which your doctor can test your ability to feel sensations on your feet.

Back to the issue of stilettoes! First, why would anyone want to wear shoes that are like stilts, knowing that breathing at that height might cause nose bleeds? That was a bad joke, but podiatrists have expressed concern about these shoes causing excessive pressure on the ball of the foot. As a woman with diabetes you must know that these shoes can be dangerous for those of us who have little experience walking on heels that high. If we have any loss of protective sensation, we won't feel the pain of pinched toes or improper gait until blisters or ulcers form, or worse. The question then may be better asked, how do we compromise? Are you willing to pay the price of these shoes to wear once and then find out they have gone out of style, concerned about yourself the entire time you are wearing them. Or would you rather invest in comfortable, safe, good looking shoes which are not a challenge to your balance, and which leave you more at east to enjoy the party, holiday ball, gala dinner, or family holiday gathering.

With your adolescent daughter, try holding the line on the shoes and "giving an inch" on the dress, curfew, etc. It will give her a sense of being in control of her life, while giving you one less thing to worry about. You might have your daughter carry a pair of "dancing slippers," even if she buys lower heels, so that when everyone kicks off their shoes to dance her feet are protected. Respecting our children by sharing medical information at a level that they are able to understand is important if they are going to be able to care for themselves and their diabetes on a daily basis.

The bottom line is that anyone with diabetes must take care when selecting shoes. Only buy properly fitted shoes which protect and cover your feet, making sure that the shoes allow room for your toes to be in their natural position. Learn how to properly care for your feet on a daily basis, and, should a problem occur, consult your doctor immediately.