Monday, 13 June 2011

Footwear Recommendations for Effective Diabetic Foot care

Reduction of  pressure, or off-loading is in essential aspect of diabetic wound care.  Foot pressures, shock and shear can be reduced with appropriately fitted footwear, insoles and socks. Total non-weight bearing, which allows the wound to be at rest, is the most ideal method of relieving pressures but it is hardly practical.  It is therefore necessary that care must be taken in selecting the most appropriate footwear as any inappropriately applied device may cause additional problems like exacerbation of postural instability, acute infection, deep ulcers accompanied by additional contraindications.   


The guidelines for selectiong the appropriate off-loading devices are:

The ability to effectively remove all pressures from the ulcer site. Cost effectiveness Ease of use,    Ability to address the characteristics of the diabetic ulceration. Ability to encourage patient adherence,Treatment and Wound Mangament

The primary goal in the treatment of diabetic foot ulcers is to obtain wound closure as expeditiously as possible.  The resolution of foot ulcers and decreasing the rate of recurrence can lower the probability of lower extremity amputation in patients with diabetes.  Orthotics are custorn made devices which serve to correct misalignments and relieve pressures in the foot. Studies have estabilished the efficacy of footwear related pressure relieving  and have concluded that in-shoe orghotics are of benefit. 


Principles of Protective footwear

Neuropathic diabetic patients with a history of foot ulceration have abnormally high pressures under the foot.  These have to be reduced to prevent further risk and damage to the foot.  One of the possible solutions is to use Protective or Therapeutic footwear consisting of custom made inserts.  These inserts generally incorporate force redistributing features. The main characteristics of protective foot wear can be summarized as shown:


To prevent injury from heat, objects, etc.


To lessen the effect of muscle-wasting and to give a soft surface for any hard, bony projections which can be felt.


To increase the weight-bearing area and to take weight off the affected area.


To reduce the effect of sheaing stress, to stabilize the foot and correct mobile deformity.

Variety of Therapeutic Footwear

Effective footwear management and getting patients with diabetes to realize the importance of well-fitting shoe gear is a crucial component in the rehabilitation process of the diabetic patient.  Ill fitting shoes stimulate lesions, often placing patients who lack foot sensation at greater risk for complications.  Research has clearly shown that podiatrists and foot-care specialists can reduce foot complications by between 45% to 75% simply by developing and implementing a comprehensive and specialized foot care regimen that employs appropriate footwear as a critical component.

While discussing footwear selection, the podiatrists and foot-care specialists can reduce foot-care specialist should rely on the patients risk level to determine the allowable range of footwear. The patient with a high risk foot, as evidenced by a prior ulcer or amputation, Peirpheral Vascular Disease, insensitivity with structural deformity or Charcot foot, should be prescribed either custom moulded or extra depth footwear with tri-layered total contact insoles. Internal and external modifications may be added depending on bionechanics and pressure reduction needs.

 Patients at moderate risk, such as those with neuropathy or PVD without significant structural deformity, have to be given a pair of properly fitting footwear with soft soles, soft uppers and appropriate insoles.

Those at low risk without neuropathy of PVD may be prescribed a wider range of footwear which can be classified as general purpose comfort footwear but they should be re-evaluated every six months to keep track of any changes.



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