Diabetic Foot and Orthotic Management


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Diabetic Foot symptoms, and how Orthotics can help make life and mobility better


  • HI. May I please use some of this for a presentation on orthotic care for the diabetic foot? If so, could you please email me a copy on riaenjosh@yahoo.com
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  • nice presentation. I nee this presentation for my study, so please send to my email alfionitawika@gmail.com Thanks
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  • thanx soo helpfull
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  • so nice presentation..please send me at my e-mail jeryqq@sina.com
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  • That is an excellent point. There are several diseases/diagnoses that can cause peripheral neuropathy similar to diabetes. I see so many people with complications due to diabetes that it is a main concern for me. I think that I have only seen two people who have had leprosy in the 20 years that I have been practicing. Side effects from medication and alcoholism are other causes of peripheral neuropathy that I see (only once in a while though). Thanks again!
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Diabetic Foot and Orthotic Management

  1. 1. Orthotic Management of the Diabetic Foot<br />The Orthotic Centre<br />At St. Joseph’s Healthcare, Hamilton<br />Linda LaaksoB.Sc.C.O.(c)<br />Certified Orthotist<br />www.customorthotic.ca<br />
  2. 2. Orthoses<br />Any device that is used to support, align, protect or correct a body part.<br />www.customorthotic.ca<br />
  3. 3. The Certified Orthotist<br />a specialized healthcare professional <br />who measures, designs, fabricates, fits, or services orthoses, and/or assists in the formulation of orthoses. <br />Governed by Canadian Board for Certification of Prosthetists and Orthotists (CBCPO)<br />www.customorthotic.ca<br />
  4. 4. Certified Orthotist and the Wound Team - Taking the pressure off<br />Treat the Cause – assess and modify situations where pressure may be increased”*<br />* “Pathway to Assessment/Treatment of Pressure Ulcers” in the RNAO Best Practice Recommendations<br />www.customorthotic.ca<br />
  5. 5. Diabetic Autonomic Neuropathy – Nerve Damage<br />Impairment of sweat glands <br /><ul><li>Dry feet</li></ul>Increased dilation of arterioles (excess of blood) and joint/tissue damage<br /><ul><li>Charcot Foot</li></ul>www.customorthotic.ca<br />
  6. 6. Diabetic Autonomic Neuropathy – What can be done?<br />Skin care<br />Moisturize<br />Wear shoes that fit well<br />www.customorthotic.ca<br />
  7. 7. Diabetic Motor Neuropathy – Loss of Intrinsic Muscle<br /><ul><li>Muscle imbalance – “claw foot”</li></ul>Causes high pressure area at metatarsal <br />heads, PIP joints and distal tips of toes.<br /><ul><li>Loss of ankle/foot </li></ul>dorsiflexors causes “drop foot”<br />www.customorthotic.ca<br />
  8. 8. Diabetic Motor Neuropathy – What can be done?<br />For Muscle Imbalance – Foot Orthoses (FO)<br />For Drop foot – Ankle Foot Orthosis (AFO)<br />www.customorthotic.ca<br />
  9. 9. Sensory Neuropathy – Loss of Protective Sensation<br />Cannot feel foreign objects in shoes<br />Not aware to change gait to protect feet<br />Ill fitting shoes (too tight)<br />www.customorthotic.ca<br />
  10. 10. Sensory Neuropathy – What can be done?<br />Education/Behaviour<br /><ul><li>Check footwear for foreign objects
  11. 11. Always wear appropriate footwear
  12. 12. Daily foot check
  13. 13. Proper shoe fitting</li></ul>www.customorthotic.ca<br />
  14. 14. Pressure = Force/area<br />Pressure is inversely proportional to surface area that force is applied<br />Force – mass x acceleration – hard to change<br /><ul><li>Area – can we change the size, shape or contour of the area over which the force is applied?</li></ul>www.customorthotic.ca<br />
  15. 15. What can be done to Re-distribute Pressure?<br /><ul><li>Foot Orthoses (FO)
  16. 16. Orthopaedic Shoes
  17. 17. Cast Boot
  18. 18. Total Contact Cast (TCC)
  19. 19. Bracing </li></ul>www.customorthotic.ca<br />
  20. 20. Foot Orthoses<br />designed to correct/accommodate foot deformities<br />usually fabricated from a plaster impression of the feet<br />Materials selected based on the requirements of the individual<br />www.customorthotic.ca<br />
  21. 21. Foot Orthoses / Orthopaedic Shoes<br />Additions or changes to a shoe to improve fit and or function<br /><ul><li>Rockered sole or buttress</li></ul>www.customorthotic.ca<br />
  22. 22. Orthopaedic shoes<br />www.customorthotic.ca<br />
  23. 23. Rockered bottom shoe<br />www.customorthotic.ca<br />
  24. 24. Cast Boot<br />Prefabricated boot used to immobilize foot and ankle and reduce motion<br />www.customorthotic.ca<br />
  25. 25. Total Contact Cast (TCC)<br />www.customorthotic.ca<br />
  26. 26. Orthopaedic Bracing - Orthoses<br />Made to a plaster impression of the body part<br /><ul><li>AFO – Ankle Foot Orthosis
  27. 27. Flexible; for drop foot
  28. 28. Rigid; provides more stability for club foot
  29. 29. Hinged; provides control with motion
  30. 30. Tubular; circumferential AFO, lined and padded
  31. 31. CROW; Charcot Restraint Orthotic Walker – total contact AFO with rubber outsole and custom insole</li></ul>www.customorthotic.ca<br />
  32. 32. CROW – Charcot Restraint Orthotic Walker<br />Custom Long-term Total Contact Cast<br />Made from plaster impression<br />Removable<br />Durable<br />Cleanable<br />Custom made “foot orthosis”<br />Rockered bottom outsole<br />Rigid ankle<br />Total Contact   Area<br />www.customorthotic.ca<br />
  33. 33. Thank you!<br />For a free copy of this presentation, please contact Linda at lindalaakso@customorthotic.ca<br />www.customorthotic.ca<br />