The information below is cited with thanks from the National Library of Medicine (PubMedCentral – World Journal of Diabetes)
Orthotic Approach to Prevention and Management of Diabetic Foot: A Narrative Review (Min Cheol Chang , Yoo Jin Choo , In Sik Park, Myung Woo Park , Du Hwan Kim)
What is a Diabetic Foot?
“Diabetic foot is an infection, ulceration, or destruction of the tissues of the foot. It is associated with neuropathy and/or peripheral artery disease in the lower extremity of a person with diabetes mellitus. The global annual incidence of diabetic foot ulcers in patients with diabetes was reported to be approximately 2%-5%, with a lifetime risk ranging from 15%-20%.
According to a report by the American Diabetes Association, 20% of patients with diabetes are hospitalized because of foot problems. The main underlying causes of diabetic foot ulcer are peripheral neuropathy and ischemia due to peripheral vascular disease. Once a foot ulcer develops, it may progress to foot infection, which if incurable, could eventually require limb amputation.
How are Diabetic Foot Ulcers Caused?
Most diabetic foot ulcers are caused by repetitive trauma due to weight-bearing or poorly fitting footwear, and ulcers often recur if the weight-bearing is not suppressed and the biomechanical abnormality of the foot is not controlled]. Prevention is important for effective management of the diabetic foot, with methods including continuous education and proper footwear for the patients with diabetes. Such methods have been reported to prevent approximately 80% of all limb amputations due to diabetes.
Education is Key
Unfortunately, however, many patients are unaware of the diabetic foot, have never received proper education on its prevention, for example by wearing adequate shoes, or often receive treatment only after the problems, such as foot ulcers and neuropathic arthropathy, occur. Therefore, it is essential for clinicians dealing with diabetic foot to be aware of the possible feet abnormalities due to diabetic complications and the importance of educating the patients with diabetes, including wearing the right footwear.”
Charcot Arthropathy
“Another disease that can occur frequently as a complication of diabetes is Charcot arthropathy. The pathogenesis of Charcot arthropathy is not clearly known yet. It is believed to be a phenomenon in which the bone is weakened due to severe bone deficiency caused by autonomic nervous system abnormality or a local increase in blood flow to the bone. Weakened bones are prone to fractures even under a very small weight, and the ligaments may also weaken, resulting in dislocation or subluxation.
Patients with Charcot arthropathy fail to sense pain in their limbs and continue to apply their weight, leading to bone deformity that further changes the normal force transmission path; this increases the chance of a fracture or dislocation and, consequently, deforms the weight-bearing part. Over time, the process stops, and the deformity becomes permanent. Owing to the dislocation, the load cannot be distributed effectively and stably during walking, resulting in movement limitations, and the persisting bone protrusion eventually causes foot ulcers.”
Charcot Foot and Collapsed Arch
“Furthermore, Charcot foot is characterized by a collapsed arch. The non-surgical treatment for Charcot arthropathy is based on off-loading and edema control principles. The goal is to prevent the foot ulcers by minimizing mechanical stress, reducing edema, and creating structural stability, all of which help in restricting the weight-bearing and stabilizing the joint until the Charcot arthropathy is sufficiently controlled.
Orthoses play a very important role in treating diabetic feet that have already developed foot ulcers and Charcot arthropathy. Orthotic devices not only provide stability, limit the joint movement, and control foot deformity, but also relieve the load and evenly distribute the pressure on the foot. As a result, orthoses can effectively heal foot ulcers and control the symptoms of Charcot arthropathy. This review describes the management of diabetic feet using properly fitting shoes and orthoses”.
The information below is cited with thanks from the British Association of Prosthetists and Orthotists (BAPO) website: https://www.bapo.com/wp-content/uploads/2018/01/The-Diabetic-Foot.A4-Dble-sided-FINAL-pdf.pdf
Common Orthotic Treatment in Diabetes
“Factors including nerve damage and foot deformity increase the risk of mechanical trauma to the diabeticfoot, while vascular disease and high blood sugar levels reduce the tissue’s ability to heal. By alteringpressures applied to the foot, foot orthoses, therapeutic footwear and other orthotic devices protect at-riskfeet and facilitate healing.
The National Institute for Health and Care Excellence (NICE) state that anyperson with two risk factors for ulceration (high risk), or who has previously had a foot ulcer, should beassessed for treatment with foot orthoses and therapeutic footwear to reduce their risk of ulcerating, orre-ulcerating.
One study showed this to reduce re-ulceration rates from 79% to 15% and amputation ratesfrom 54% to 6%. In terms of monitoring and education, orthotists offer regular reviews where educationand foot care advice is provided and referral to the high risk foot clinic is facilitated if necessary.”
Curafoot Orthotics
Bookyour appointment today for a Consultation on Custom Orthotics and Treatment for Diabetic Foot Conditions at the Curafoot Clinic.Call ……. Email ………
Curafoot – India’s No.1 Mobility Clinic
The Curafoot Clinic is situated at Ajoynagar in Kolkata. It also offers foot diagnosis and scanning facilities at other hospitals and clinics in the city, such as Apollo Multispeciality Hospital. Additionally, there are Curafoot Partner Clinics offering Foot Scanning Facilities and Custom Orthotics around the country, for example, in cities such as Bhubaneshwar. The Curafoot Clinic provides consultations for numerous Foot and Ankle Problems, Custom-fit Orthotics, Podiatry and CuraProsthetics.
