Diabetic Foot and Orthotic Management

Orthotic Management of the Diabetic Foot
The Orthotic Centre
At St. Joseph’s Healthcare, Hamilton
Linda LaaksoB.Sc.C.O.(c)
Certified Orthotist
www.customorthotic.ca

Orthoses
Any device that is used to support, align, protect or correct a body part.

The Certified Orthotist
a specialized healthcare professional
who measures, designs, fabricates, fits, or services orthoses, and/or assists in the formulation of orthoses.
Governed by Canadian Board for Certification of Prosthetists and Orthotists (CBCPO)

Certified Orthotist and the Wound Team- Taking the pressure off
Treat the Cause – assess and modify situations where pressure may be increased”*
* “Pathway to Assessment/Treatment of Pressure Ulcers” in the RNAO Best Practice Recommendations

Diabetic Autonomic Neuropathy – Nerve Damage
Impairment of sweat glands

Dry feet

Increased dilation of arterioles (excess of blood) and joint/tissue damage

Charcot Foot

Diabetic Autonomic Neuropathy – What can be done?
Skin care
Moisturize
Wear shoes that fit well

Diabetic Motor Neuropathy – Loss of Intrinsic Muscle
Muscle imbalance – “claw foot”
Causes high pressure area at metatarsal
heads, PIP joints and distal tips of toes.

Loss of ankle/foot

dorsiflexors causes “drop foot”

Diabetic Motor Neuropathy – What can be done?
For Muscle Imbalance – Foot Orthoses (FO)
For Drop foot – Ankle Foot Orthosis (AFO)

Sensory Neuropathy – Loss of Protective Sensation
Cannot feel foreign objects in shoes
Not aware to change gait to protect feet
Ill fitting shoes (too tight)

Sensory Neuropathy – What can be done?
Education/Behaviour

Check footwear for foreign objects
Always wear appropriate footwear
Daily foot check
Proper shoe fitting

Pressure = Force/area
Pressure is inversely proportional to surface area that force is applied
Force – mass x acceleration – hard to change

Area – can we change the size, shape or contour of the area over which the force is applied?

What can be done to Re-distribute Pressure?

Foot Orthoses (FO)
Orthopaedic Shoes
Cast Boot
Total Contact Cast (TCC)
Bracing

Foot Orthoses
designed to correct/accommodate foot deformities
usually fabricated from a plaster impression of the feet
Materials selected based on the requirements of the individual

Foot Orthoses / Orthopaedic Shoes
Additions or changes to a shoe to improve fit and or function

Rockered sole or buttress

Orthopaedic shoes

Rockered bottom shoe

Cast Boot
Prefabricated boot used to immobilize foot and ankle and reduce motion

Total Contact Cast (TCC)

Orthopaedic Bracing - Orthoses
Made to a plaster impression of the body part

AFO – Ankle Foot Orthosis
Flexible; for drop foot
Rigid; provides more stability for club foot
Hinged; provides control with motion
Tubular; circumferential AFO, lined and padded
CROW; Charcot Restraint Orthotic Walker – total contact AFO with rubber outsole and custom insole

Custom Long-term Total Contact Cast
Made from plaster impression
Removable
Durable
Cleanable
Custom made “foot orthosis”
Rockered bottom outsole
Rigid ankle
Total Contact   Area
CROW – Charcot Restraint Orthotic Walker

Thank you