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Can you give me some suggestions on what would be the ideal insole materials to be used on diabetic patients? We are currently milling EVA of different hardness but can you share your experience and suggestions on milling materials and top covers for diabetics patients? The aim is to give an accomodative orthoses to prevent occurrence or recurrence of ulcers and provide some arch support to prevent plantar fascitis etc. Thanks,

 

Hi Vnsriram :welcome: to Podiatry Arena.

The best insole for Diabetics is one with the lowest Friction co-efficient ie to reduce surface shear and friction.

 

This is what we do:
First visit when dealing with a wound the foot is wrapped in12mm intuition foam
( http://www.ortoped.ca/pdf/Intuition_Foam.pdf )
and a surface matched insole is provided in an extra depth/width shoe and or walking boot depending on the severity and where it is located. It MUST be surface matched to reduce peak pressures on the plantar surface. Communication with the team is a must because the dressings are at that point needing accomadation as well so consistent dressing protocol is quite important to ensure proper peak pressure control. The enterostomal therapist will work the wound and I will ensure it is offloaded. Follow ups weekly until healing then provided again a surface matched insole of soft eva lined with PPT then covered with 2 mm neoprene. The cushioning is obvious as to the benefit but the surface match is where the real positives come to play. The the shear reduction is provided by the neoprene.

Now, this has been done this way as a result of trial and error over time at the Sheldon Chumir wound clinic in Calgary Alberta.
http://www.albertahealthservices.ca/services.asp?pid=saf&rid=1072810
This is a wonderful clinic with a group of very caring individuals. I was a bit skeptical at first but the results were shown to be better with this protocol.

And always, always replace them as needed. Some of these clients have hygeine that is less than desirable at times and can lead to infection as quick as you can say it. Education of the patient as to the dire consequences of thier situation is critical and that they must take the situation very seriously and protect the feet at ALL times.

Todd

 

THanks for the info. Would you advise the patient to continue using the same orthotic and would that play a role in preventing recurrence?

 

A I indicated in the last paragraph they need to be changed as needed. The patient is in a state of flux in the beginning of this routine. Changes are commonplace for them. The initial use of the intuition insole is quite cost effective so changing as needed is not an expensive undertaking when you make them yourself. I can make a new pair for them while they wait and it costs me the time (20 min) and the materials (about 4 dollars CDN)
Once they have healed is when again it is changed to reflect the new shape but a more permant one is constructed.
But even then "permanent" is a relative term. Top cover materials and packing out are things that dictate changes be made.
(for those that at this point want to ask about polypropelene and why I would not use it please ask .....but perhaps this introductory thread is not the place. )

The point I am trying to make is that there is no such thing as a permanent foot orthosis for the walking wounded. You have to follow them along and make changes to keep up with the changes thay have as they happen and to prevent changes from occurring if you can.