Footwear and Offloading for Diabetic Foot Persons Assoc. Prof.Gulapar Srisawasdi, M.D., C.Ped. Dept. of Rehabilitation Medicine Siriraj Diabetes Center Sirindhorn School of Prosthetics and Orthotics Faculty of Medicine Siriraj Hospital, Mahidol University
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Footwear and Offloading for Diabetic Foot Persons
Assoc. Prof.Gulapar Srisawasdi, M.D., C.Ped.
Dept. of Rehabilitation Medicine
Siriraj Diabetes Center
Sirindhorn School of Prosthetics and Orthotics
Faculty of Medicine Siriraj Hospital, Mahidol University
Definition of Footwear
Shoes
Insoles & Orthosis
Socks
Offloading Concept
Facts about Load on Foot
Plantar pressure distribution during standing barefoot
Heel 60%
Midfoot 8%
Forefoot 28%
Toes 4%
Walking
Peak vertical forces 120% BW
Running
Peak vertical forces 275% BW
Facts about Load on Foot
peripheral neuropathy vascular occlusion
insensate, deformed and dry feet
poor diabetes control
callus & ulcer
Amputation
Infection
repetitive pressure &
unrecognized trauma
FOOT COMPLICATION
ULCERATION AMPUTATION
DM Foot Cycle & Roles of Footwear
Footwear and off-loading for the DM foot: an evidence based guideline
Treatment of ulceration
Prevention of ulceration
2015 IWGDF Guidance for Footwear and Offloading
Inappropriate footwear and walking barefoot or in thin-soled standard slippers with insensitive feet are major causes of foot ulceration.
Patients with loss of protective sensation should have access to appropriate footwear without financial restraints.
2015 IWGDF Guidance for Footwear and Offloading
2015 IWGDF Guidance for Footwear and Offloading
Do not prescribe, and instruct a patient with diabetes not to use, conventional or standard therapeutic shoes to heal a plantar foot ulcer.
Total contact cast
Ankle foot orthosis (AFO)
Foot orthosis
Shoe & Shoe modifications
Custom molded shoes
Off-loading Modalities
Total Contact Cast
Weight distribution
Increased contact area 15-24 %
Decreased average pressure 40-80 %
Decreased healing time
Best for ulcer grade 1 and 2
To heal a neuropathic plantar forefoot ulcer without ischemia or uncontrolled infection
1st non-removable knee-high device with an appropriate foot-device interface
2nd removable (patient agree to adhere to wearing the device)
3rd forefoot offloading shoe, cast shoe, or custom-made temporary shoe (patient agree to adhere to wearing the device)
2015 IWGDF Guidance for Footwear and Offloading
Prefabricated Knee-high Device with an Appropriate Foot-device Interface
Patella Tendon Bearing AFO
Common Foot Orthosis for DM
Total Contact Orthosis
Functions* Weight distribution
Shock absorption
Decreased shearing force
Protect pathologic area
Limit motion of affected joint
Best result with proper shoes
*Janisse DJ. A scientific approach to insole design for the diabetic foot. Foot 1993; 3: 105-108.
Common Shoe Modification for DM
Rocker bottom soles
Functions
Relieve pressure to specific area
Replace motion
Improve gait
Decrease shock
Custom Molded Shoes for Severe Deformity
2015 IWGDF Guidance for Footwear and Offloading
Risk Category Footwear
0 No peripheral neuropathy
Off-the-shelf footwear
1 Peripheral neuropathy must take extra care when selecting or being fitted with footwear
2 Peripheral neuropathy with PAD and/or a foot deformity
Therapeutic footwear
3 Peripheral neuropathy and a history of foot ulcer or LE amputation
Shoes for DM Persons
Proper shoes Improper shoes Vinyl or plastic shoes