Foot Orthoses and Diabetic Ulcers

Kevin Kirby · Aug 22, 2013

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For those that are interested, David Armstrong and myself were interviewed for a recently published article on therapeutic effectiveness of custom foot orthosis in treating diabetic neuropathic ulcers in Podiatry Today magazine.

Can Orthotics Prevent Re-Ulceration In Patients With Diabetes?

Craig Payne · Aug 23, 2013

I tweeted this last month to get a bite:

Who said orthotics don't work? After 2 yrs of orthotics in diabetes, reulcerations drop: 79% to 15%, amputations 54% to 6%.
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...no one bit!

It was based on this study in JAPMA.

Admin2 · Aug 23, 2013

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Footwear and offloading interventions to prevent and heal foot ulcers

Dr. Steven King · Aug 26, 2013

Aloha,

Plantar redistrubution of force and shear is paramount for healing and protection for DM wounds as well as stress fractures.

Use of an external sole rocker or the newer technology of using a levered internal midsole shoe rocker can achieve this.

Use of compressable foams to donut hole a lesion is helpful or the newer technology of using a composite spring plate with lesion cuttouts is very helpful to not only reduce pressure but shear as well by transfering the force distally and plantar through the spring plate. Modified carbon fiber dynamic AFO's work very well for this but have only been really used for stroke support.

Mahalo,
Dr. King

Co-Principal Investigator SBIR A11-109 "Advanced Composite Insoles for the Reduction of Stress Fractures." US Department of Defense and Army Medical Research and Materials Command,

rdp1210 · Aug 27, 2013

Kevin Kirby said: ↑

For those that are interested, David Armstrong and myself were interviewed for a recently published article on therapeutic effectiveness of custom foot orthosis in treating diabetic neuropathic ulcers in Podiatry Today magazine.

Thanks Kevin, :)

As you know, a majority of my biomechanics practice now is devoted to diabetics. While the literature statistics do support our contention about prevantive measures, what I have found invaluable the last two years is the implementation of pedobarograph studies on those high risk patients. I am now a full convert to pedobarograph utilization for the high risk diabetic patient who is treated with foot orthoses. You've find out real quick that some of them you're very successfully alleviating pressure, but others you find out that you're not doing the job you think you're doing.

I note that people talk a lot about shear, however you can't have a shear force without a vertical force, so reduction in vertical force also does result in a decrease in shear force. It's important to remember that most of these diabetics have soft tissue biomechanical problems, i.e. motor neuropathy and collagen glycosylation, that we really have not addressed quantitatively in the clinic. I find it interesting that we use orthotics with the same durometer on the top surface for a foot that does not have the same durometer measure across the plantar surface.

Of particular interest are the diabetics who have already had a portion of the foot cut away. :bang: I am chagrined at how aggressive some surgeons are in debriding bone that is proximal and distal to the infected bone, without any thought about what the final function will be. I am constantly challenged by the TMA patient, where I notice a great majority have chronic reulceration problems at the distal end of the amputation. Many (but not all) of these did not have TAL procedure with the TMA. Other challenging patients are the ones with charcot feet and also total first ray amputees. My personal opinion is that once a surgeon intervenes with resection of bone for osteomyelitis, he/she becomes responsible for treating that patient's consequential foot function for the rest of the patient's life. My experience here in FL has been that most of the foot surgeons cut parts off and then defer the result to someone else to deal with.

Will hopefully have more to contribute in the future on this most important subject,
Best wishes,
Daryl
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NewsBot · Jan 2, 2018

Effect of medial and lateral heel wedge changes On mechanical parameters of diabetic foot ulcers during gait.
Abdi E, Eslami M, Taghipour M.
J Sport Biomech. 2017; 3 (3) :3-4

Background: Still using the slope strategy on foot to reduce peak pressure and the pressure there is confusion. Therefore, the objective of this study was to evaluate the effect of internal and external wedge slope changes on the mechanical parameters foot ulcers.
Methods: In this quasi-experimental study of 15 diabetic patients with an average age of 63.3±2.01 was used. The presence of 3, 6, 9 and 11 in both internal and external conditions we cover. Patients wearing the wedge in 9 separate efforts from the foot scan RS-scan data collection and analysis of variance for repeated data was prepared.
Results: Compared with the control condition (bare feet), each lateral heel wedge significantly reduced peak pressure on 3, 4 and 5 metatarsal head (p=0.01), but, significantly increased peak pressure on 1 and 2 metatarsal head (p=0.01). Each medial heel wedge significantly reduced peak pressure on 1 and 2 metatarsal head (p=0.01), but, significantly increased peak pressure on 3, 4 and 5 metatarsal head (p=0.01) Time pressure integral showed a significant increase at the 3, 4 and 5 Metatarsal head area in the 3 lateral heel wedges, 9 and 11 degrees of medial heel wedges, And 1 and 2 metatarsal head regions was significant increase on the 9 and 11 degrees external and 11 degrees medial heel wedges (p=0.01).
Conclusions: These findings indicate that heel wedges change effect was significantly different between the peak pressure and peak pressure time integral on the metatarsal head regions. A median slope of 6 degrees can also be suitable for reducing the peak pressure in the three, four, and five metatarsal head, as well as a 6 degree can also be suitable for reducing the peak pressure in the metatarsal head.
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