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Orthotic for a diabetic

Discussion in 'General Issues and Discussion Forum' started by Simon Ross, Nov 10, 2014.

  1. Simon Ross

    Simon Ross Active Member

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    A patient came to see me the other day with some callous. She is a diabetic, and has a forefoot valgus.

    Due to this foot structure, is it not best practise to suggest an orthotic for long term treatment? She will be more prone to developing callous problems, which may ulcerate.

    She claims that she does not need an orthotic as "the NHS are stretched financially as it is" My viewpoint is that an orthotic will save the NHS money long term, by preventing problems.

    What do others think please?

    Neil Baker (who I hold a lot of respect for like Ivan Bristow) I'm sure said can't treat the diabetic foot, without considering biomechanics.
  2. Boots n all

    Boots n all Well-Known Member

    For me its a yes Simon, l remember reading that a diabetic has a 15% chance of developing a foot ulcer, imagine the potential money that could be saved with this approach.
    The right orthoses in the right shoe and a compliant client is a wining combination.
  3. footplant

    footplant Active Member


    Where is the callus and how severe is it? What is the plantar tissue over the metatarsal heads like? What is the sensation like? If there is neuropathy and callus I would personally probably be recommending foot orthoses, and more strongly if the neuropathy or callus was marked. Of course compliance and footwear would also come into it. That would also be my interpretation of the NICE CG10 algorithm, which recommends 'evaluate provision of and provide appropriate...specialist footwear and insoles' for a foot with a 'risk factor' (e.g. neuropathy) and 'skin changes'.

  4. Simon Ross

    Simon Ross Active Member

    Callous is lateral L/4th toe (there was a slight haematoma there), and medial digit 1 B/F (not too heavy)

    First of all thank you very much for your replies, very kind of you. Following what Neil Baker said at Glasgow 2012 SCP conference, I would say that orthotics should be considered.

    This patient who originally wanted to be referred to the NHS for an orthotic, now claims to me in (what could be considered to be a very snotty toned e-mail), that she does not want orthotics, as, "the NHS is already over-stretched financially".

    I would argue that the cost of an orthotic is much less than the cost of a possible ulcer forming there, and amputation. OK, neuro-vas wise, she is OK, but she has a forefoot valgus, and that needs addressing, as there is callous formation occurring.

    I am not an expert in biomechanics, but surely a referral to an NHS pod who is very experienced, will know if an orthotic is required, long term prognosis wise!

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