DIABETES MELLITUS

DIABETES MELLITUS CORRECT FOOTWEAR FOR GRADE 1 FOOT PRESENTED BY KSRS.PRASAD

OUR INSPIRATION • OBSERVATIONS IN VARIOUS MEDICAL TEXT BOOKS, JOURNALS AND FINALLY IN THE INTERNATIONAL CONSENSUS ON THE DIABETIC FOOT • ST.VINCENT DECLARATION WHICH AIMS AT REDUCING AMPUTATIONS OF THE LOWER LIMB IN DIABETICS BY 50%

THERAPEUTIC/PROTECTIVE FOOTWEAR • Therapeutic footwear is used to remove the mechanical load off the foot • Total contact cast/orthoses may be used • Protective footwear should include footwear for both indoor and outdoor use • Protective footwear is based mainly on accommodation,cushioning and stabilisation • Patients should know that wearing appropriate footwear is a life-long commitment and even short periods of wearing inappropriate footwear may result in an ulcer • Ill-fitting shoes cause ulcers to the digits or the dorsum

HOW TO PREVENT FOOT PROBLEMS? • REGULAR EXAMINATION OF THE “AT RISK” FOOT • IDENTIFYING OF PATIENTS WITH “AT RISK” FEET • SIMPLE AND REPETITIVE EDUCATION TARGETED AT HEALTHCARE PROVIDERS AND PATIENTS • ADEQUATE PREVENTIVE FOOT-CARE IRRESPECTIVE OF SOCIO-ECONOMIC STATUS • PERCOLATION OF KNOWLEDGE THAT THERE IS NO SUCH THING AS A TRIVIAL LESION OF THE DIABETIC FOOT • MULTIDISCIPLINARY FOOT-CARE TEAMS

CORRECT DIABETIC FOOTWEAR CONSIDERATIONS • THE SOLE • THE INSOLE • THE UPPER • THE DESIGNS • MAKING PRINCIPLES • FITTING PROCEDURE • FOOTWEAR CARE/ FOOTWEAR ORTHOTIC MODIFICATIONS

THE SOLE • RIGID SOLE/ROCKER BOTTOM SOLE IN FORE FOOT ULCERS • BROAD/LIGHT/TOUGH SOLE • LOW HEEL/FLAT BOTTOM SOLE WITHOUT A SEPARATE HEEL • SOLE WITH GOOD ANTI-SKID GRIP/ ROUNDED AT HEEL FOR EASY HEEL STRIKE/ RESPECTABLE WALKING ANGLE FOR TOE-OFF WITHOUT PRESSURE ON METATARSALS

THE SOLE CONT.. • HEEL PITCH TO ACCOMMODATE PHYSIOLOGICAL FLEXION OF THE KNEE (PREVENTS HYPEREXTENTION OF KNEE AND PAIN OF HAMSTRINGS THEREOF). THE HEEL SHOULD ALSO SUPPORT THE ARCH • THE SOLE IS NOT SOFT AND DOES NOT SINK UNDER THE BODY WEIGHT( A SOFT SOLE CAN CAUSE DORSIFLEXION OF THE FOOT CAUSING STRAIN ON HAMSTRINGS AND ENERGH LOSS)

THE SOLE CONT… • NOT FLEXIBLE AND SO DOES NOT CAUSE TOE-BREAK OR HIGH PRESSURE ON THE METATARSALS • THE SOLE SHOULD NOT BE THICK CAUSING EXCESSIVE GROUND CLEARENCE MAKING THE ANKLE VULNERABLE TO FRACTURES • WE ARE WORKING ON A SPECIAL CONVERTABLE COMBINATION SOLE THAT SHOULD SERVE ALL THE NEEDS OF DIABETIC FOOT

OUR CRITICALLY IMPORTANT SPECIAL POLYMER INSOLE • EXCELLENT COMPRESSIVE STRENGTH-Significantly higher than even PU foam/has a smooth surface and a soft feel • EXCELLENT RESILENCE-Has excellent recovery after repeated flexing/compression • VERY GOOD TENSILE AND TEAR STRENGTH-Remarkably tough/capable of taking repeated harsh treatment with little effect • OUTSTANDING MOISTURE RESISTANCE- Closed cell structure/hydrophobic/water absorption and water vapour transmission rates are negligible

SPECIAL MCP INSOLE CONT.. • CHEMICAL RESISTANCE- Has excellent chemical stability when exposed even to acids,paints,varnishes,thinners and alcohols • THERMAL INSULATION-Excellent thermal insulator and is 35% better than any other soft foams • SERVICE TEMPERATURE- Can be used in temperatures up to 70 degrees centigrade without significant effect on its properties • BUOYANCY-Its low density,closed cell structure and water proof properties allow MCP to remain buoyant even when sliced or punctured

SPECIAL MCP INSOLE CONT… • 15+2 Degree Shore A Insole as per Medically Accepted Standards. This softness minimises shock to the plantar surface and prevents sub-cutaneous hemorrhage. • 8mm Thick to suit even heavy persons • Establishes total contact with the foot on regular use thereby reduces Neutons( pressure) per unit area of the foot (ANASTOMOSIS). • No Designs or Patterns on the Insole as these are found to affect the Plantar Pulp.

SPECIAL MCP INSOLE CONT… • No Arch supports given as it is never possible to provide an accurate arch support to all( it is never uniform). A higher than necessary arch support causes inversion of the foot and leads to undue pressure on the lateral arch • The insole establishes Total Contact and forms natural and correct arch supports • The insole is not pasted in the shoes and can be conveniently replaced whenever called for • We are working on many superior polymers, Total Contact insole techniques and materials

THE UPPER MATERIALS • IDEALLY SOFT LEATHER • SOFT POROMERIC MATERIALS • THE LINING HAS TO BE LEATHER OR POROMERIC • CLIMATIC CONDITIONS TO BE GIVEN ULTIMATE IMPORTANCE IN FINALISING UPPER/ LINING MATERIALS • NON-WOVEN FABRIC LINED UPPERS IN SANDALS UNDER STUDY TO DEVELOP ECONOMIC FOOTWEAR

DESIGN-SANDALS • ONLY BROAD STRAPS(NO NARROW STRAPS/NO WEBBING) • NO TOE-RING/NO TOE-STEM • FULL OR ADEQUATE HEEL COUNTER • ADJUSTABLE UPPERS TO ACCOMMODATE OEDEMA • NO THICK THREAD STICHING ESPECIALLY IN THE QUARTER

DESIGN-SANDALS CONT… • CUT, PASTE AND LAST METHOD MOST IDEAL • PROPORTIONATE AND ACCURATE WINDOWS AT THE 1ST AND 5TH METATARSALS MANDATORY • NON-ADJUSTABLE UPPERS FOR THOSE NOT HAVING THE PROBLEM OF OEDEMA IS ACCEPTABLE • MAXIMUM COVER OF THE FOOT MEANS MAXIMUM PROTECTION

DESIGN-SANDALS CONT… • NO HARDWARE/ BUCKLES WITH THONGS • ONLY VELCRO STRAPS AND SOFTER FORM OF VELCRO TO FACE THE SKIN • EASY TO WEAR DESIGNS KEEPING THE AGE GROUP AND ACCOMPANYING MUSCULO-SKELETAL PROBLEMS IN VIEW • DESIGNS FINALISED AFTER THOROUGH TRIALS ON GOOD NUMBER OF SUBJECTS ON A TWO- TIER BASIS

DESIGN-SHOES • BROAD TOE • RAISED TOE • WIDE FITTING ACROSS THE FOOT • MINIMUM STIFFENER AT TOE BOX/HEEL COUNTER • ONLY DERBY MODELS WITH LACE/VELCRO FASTNERS(NO SLIP-ON MODELS) • INSOLE NEVER PASTED-REPLACABLE

DESIGN-SHOES CONT… • NO THICK THREAD STICHING IN THE QUARTER • SOFT AND CONTINUOUS COLLAR MANDATORY • PUNCHED HOLES FOR LACE AND NO ISLETS • LACE WITHOUT METAL TIPS • MODELS FINALISED AFTER PROPER TRIALS

MAKING PRINCIPLES • EXTRA DEPTH SHOES • UNIFORMLY THICK INSOLE AT BOTH HEEL AND TOE TO PREVENT EQUINUS • SKILLFUL LASTING PROVIDES WALKING ANGLE • NAILS/SHARP OBJECTS REMOVED INSIDE SHOES AFTER LASTING

MAKING PRINCIPLES CONT… • SOFT SIDE OF VELCRO TO FACE THE SKIN • NO THICK THREAD STICHING INSIDE THE SHOE • NO METAL ISLETS/ METAL TIPS FOR LACE • ENTIRE INSIDE OF THE SHOE TO BE FELT/ INSPECTED AND CLEARED AT THE TIME OF QUALITY CHECK

FITTING PROCEDURE • FIT SHOES LATER IN THE DAY • TAKE THE FOOT SIZE WHILE STANDING • MEASURE BOTH FEET(PROVIDE MIS MATCH SERVICE OR FIT THE BIGGER FOOT SIZE AND PROVIDE INSOLE TO ELIMINATE PLY IN THE OTHER) • FIT THE SHOE WITH THE BUYER WEARING REGULAR SOCKS • ENSURE GOOD GAP BETWEEN TIP OF TOE AND TIP OF INSIDE OF SHOE

FITTING PROCEDURE CONT… • CHECK THE FEET OF THE DIABETIC FOR POSSIBLE CHANGES DUE TO PRESSURE AFTER FIRST TWO HOURS OF USE • ADVISE GRADUAL BREAKING INTO NEW SHOES • ADVISE GOOD FOOTCARE REGIMEN • ADVISE PERIODIC MEDICAL SUPERVISION

FOOTCARE ADVISE/ PRODUCTS • PERIODIC FOOT INSPECTION • PERIODIC MEDICAL CHECK • PROPER SOCKS • PROPER PEDICURE • FOOTWEAR INSPECTION EVERYDAY • MOISTURISING CREAMS/DUSTING POWDERS ETC., DEPENDING ON FOOT CONDITION • REGULAR FOOT BATH IN WARM WATER WITH NON DETERGENT BASED ANTI MICROBIAL LOTION • NEVER TO WALK BARE FEET

FOOTWEAR MODIFICATIONS • ORTHOTIC MODIFICTIONS BY TRAINED EXPERTS • META-TARSAL BAR • MEDIAL/LATERAL WEDGE • SPLINTS • HEIGHT ADJUSTMENT • NEVER ADVISE A DITCH TO BE MADE IN THE INSOLE AS IT CAUSES PRESSURE AT THE PERIPHERY OF THE ULCER( THE ATTEMPT SHOULD BE TO DISTRIBUTE PRESSURE/SHIFT PRESSURE)

OUR COMMITMENT • OUR BACKGROUND IS THE INSPIRATION BEHIND OUR COMMITMENT • CORRECT FOOTWEAR AT ITS BEST • QUALITY AT EVERY STAGE OF MAKING-CHOICE OF MATERIALS TO MAKING OF THE PRODUCT • NO COMPROMISE PHILOSOPHY EVEN FOR COMMERCIAL GAINS • TOTAL FOOTCARE

THANK YOU YOURS IN FOOTCARE ALWAYS COMMITTED TO DIABETIC FOOTCARE

DIABETES MELLITUS