what-when-how
In Depth Tutorials and Information
1.
Relief of excessive plantar pressure: the typical daily activities of life
produce pressure on the foot which, in insensate feet, can lead to
callus formation and the development of ulceration, particularly over
areas of greatest pressure such as the metatarsal heads. Orthoses
can help to reduce these pressures by redistributing them more
evenly over the plantar aspect. However, many retail shoes do not
have sufficient depth to accommodate the foot and the foot
orthoses, and specialist therapeutic footwear may have to be
provided.
2.
Reduction of shock: even moderate pressure can cause problems
with callus and ulcer formation if it is repetitive. Cushioning materials
in both the foot orthoses and the outer sole of the footwear
contribute to the reduction of these forces.
3.
Reduction of shear: the reduction of the horizontal and vertical
movements of the foot within the footwear is important in reducing
the damaging effects of skin shear and friction which can cause
blisters, and contribute to callus formation and ultimately ulceration.
table 8.1
An algorithm for footwear and foot orthoses options for people with diabetes
Risk category
Definition
Recommended footwear
0
Protective sensation intact
Well fitted, appropriately designed
retail footwear
1
Neuropathy/no deformity
Shock-attenuating insoles and
extra-depth shoes (retail or stock
therapeutic footwear)
2
Neuropathy with mild
deformity
Extra-depth stock therapeutic
footwear with accommodative or
moulded foot orthoses
3
Neuropathy with significant
deformity and history of
pressure induced ulcer
Modular or bespoke footwear with
accommodative or moulded foot
orthoses and rocker outer sole
4
Neuropathy with severe
deformity and history of
pressure-induced ulcer and/
or amputation of toe(s)
Modular or bespoke footwear with
accommodative or moulded foot
orthoses and rocker outer sole
5
Neuropathy with complex
deformity, chronic
ulceration, partial foot
amputation or unilateral
lower limb amputation
Bespoke shoes or boots with
accommodative or moulded foot
orthoses or ankle-foot orthoses and
a rocker outer sole
