Most diabetic ulcers are secondary to an orthopedic anomaly and neuropathic foot. Healing success and healing time depend on medical factors such as a patient’s general health, controlled A1C, vascular health, and weight, to mention just a few. When the patient with Diabetic Peripheral Neuropathy exhibits gait deviations due to ankle instability, foot deformity or contracture, repeated micro trauma may cause ulceration to a particular part of the foot. Contractures of the achilles tendon can often lead to midfoot, forefoot, or digital ulcers. Likewise, ankle instability or a lax achilles tendon can contribute to heel ulceration in the insensate limb.
Maximal correction and unloading of the anomaly is imperative for the fastest possible positive outcome.
Pressure modulation in the treatment of diabetic foot ulcers, commonly referred to as “offloading,” is one of our Diabetic services. We custom fit offloading devices such as foot braces and therapeutic footwear to redistribute weight away from specific areas.
Crow Walker Boots
A CROW boot or Charcot Restraint Orthotic Walker is a custom built total contact device designed to reduce pressure and strain on the surface of the sole of the foot. It was developed for patients with severe deformity of the foot and ankle due to acute nerve damage.
OWL – WHO Heel/Forefoot Relief
These are built custom to keep the patient population ambulatory while stabilizing the foot and ankle and supporting or correcting the limb to promote all of the health benefits associated with mobility. The forefoot design may be constructed as a solid ankle or with articulated ankle and plantar-flexion stop in patients where ankle motion is desirable.
Diabetic Shoes & Custom Diabetic Shoe Inserts
Diabetic shoes, sometimes referred to as extra depth, therapeutic shoes, are specially designed shoes, or shoe inserts, intended to reduce the risk of skin breakdown in diabetics with co-existing foot disease.
The primary goal of therapeutic footwear is to prevent complications, which can include strain, ulcers, calluses, or even amputations for patients with diabetes and poor circulation. Neuropathy can also change the shape of a person’s feet, which limits the range of shoes that can be worn comfortably. The diabetic shoes and custom-molded inserts work together as a preventive system to help diabetics avoid foot injuries and improve mobility.
Custom Diabetic inserts are uniquely molded to produce a total contact orthosis that are designed to protect diabetic feet. Materials used include EVA, Cork, PPT, Plastazote etc., offer a combination of support, balance, shock absorption, accommodation and durability. These traditional orthosis total contact inserts enable diabetic patients, including those who suffer from plantar ulcerations, diabetic foot pathology and peripheral vascular disease, to ambulate comfortably.
Diabetic Toe/Partial Foot Fillers
For patients presented with toe amputation, custom ‘toe-fillers’ can be fabricated. These minimize patient discomfort, protect the insensitive diabetic foot and allow natural walking. They can be prescribed for partial, transmet, or Symes amputations.
There are various ways to lace your shoes to alleviate pain caused by foot problems such as high arches, toe problems, heel fit, narrow or wide feet, narrow heels and wide forefoot, bumps on the top of your foot, a bone that sticks out or perhaps pain from a nerve or tendon injury. Changing the way you lace your shoes may eliminate or lessen the pain and help healing.
The following are lacing tips from the American Orthopedic Foot and Ankle Society-
- Loosen the laces as you slip into the shoes. This prevents unnecessary stress on the eyelets and the backs of the shoes.
- Always begin at the bottom and pull the laces one set of eyelets at a time to tighten. This prevents unnecessary stress on the top eyelets and provides for a more comfortable shoe fit.
- When buying shoes, remember that those with a large number of eyelets will make it easier to adjust the laces for a custom fit.
- The conventional method of lacing, criss-cross to the top of the shoe, works best for the majority of athletes.