Diabetes mellitus refers to a group of diseases that affect how the body uses blood sugar (glucose). diabetic ulcer formation in diabetes.

1. DIABETES
BY ANKITA
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2. Table of contents
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04
02
05
03
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WHAT IS
DIABETES?
CLASSIFICATION
OF DIABTES
Diabeteic foot
ulcers
BIOMECHANICAL
CHANGES IN
DIABETES
DIABETEIC
PERIPHERAL
NEUROPATHY
FOOT ORTHOSIS IN
DIABETES
MANAGEMENT
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3. WHAT IS
DIABETES?
01
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4. 1. Diabetes Mellitus is a metabolic disorder characterized by high
blood sugar levels in body
2. Diabetes may be due to:
(a) Diabetes is a chronic disease that occur either when the
pancreas does not produce enough insulin or when the body
cannot effectively use the insulin it produces. Experts believe
obesity especially too much fat in the abdomen and around the
organs called visceral fat is a main cause of insulin resistance.
Hyperglycemia- high blood sugar level
Hypoglycemia- low blood sugar level
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5. CLASSIFICATION
OF DIABETES
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6. CLASSIFICATION OF DIABETES
TYPE 1
TYPE 2
GESTATIONAL DIABETES
OTHER SPECIFIC TYPES
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7. ● Type 1 : Hyperglycemia as body does not produce
insulin[Autoimmune cases]
● Type2: Cells don't respond normally to insulin i.e. insulin
resistance
● Other Specific Types:
1. Pancreatic Diabetes
2. Steroid Induced Diabetes
3. Endocrinopathies
4. Congenital Rubella
5. Down Syndrome
Gestational Diabetes : Pregnancy [Hormones-
Estrogen,Cortisol,Placental lactogen]
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8. 9
DIABETIC FOOT
ULCERS

9. ● Diabetic foot ulcers are a common complication of diabetes and can lead to serious
health issues if not managed properly. Diabetic foot ulcers are open sores or wounds
that occur on the feet of individuals with diabetes. These ulcers often develop as a
result of poor blood circulation and nerve damage, which are common complications
of diabetes. The combination of reduced blood flow and nerve damage can lead to
slow healing of foot injuries, making individuals with diabetes more susceptible to
developing ulcers on their feet.
● 10% of people with diabetes will have a diabetic foot ulcer at some point of their life.
● More than 80% of amputation in diabetes are preceded by DFU.
● In a study from North India , the prevalence of DFU among patients with diabetes was
reported to be 14.3%.
● Common site for foot ulcers-1st,2nd,3rd, and MT head. Because they have repetitive
stress most while working.
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10. STAGES OF ULCER FORMATION

11. BIOMECHANICAL
CHANGES IN DIABETES

12. 1. Windlass Mechanism stops.
 Windlass effect occurs during the pre-swing phase of gait cycle in
which the peak tensile strain and force of the plantar aponeurosis
(PA) is reached. The increased dorsiflexion angle of the 1st
metatarsophalangeal (MTP) joint is the main causing factor.
2. Decrease Stride length
3. Increased Stance phase
4. Gastrosoleus contracture leading to foot equines.
5. Uncoordinated muscles interactions leading to foot slap.

13. DIABETIC PERIPHERAL
NEUROPATHY

14.  Neuropathy is a complication of diabetes that can lead to problems throughout the body.
Diabetes can affect nerves that control movement, sensation and other functions.
 Diabetic neuropathy is a type of nerve damage that can occur in people with diabetes. It is a
common complication of diabetes and is caused by prolonged high levels of blood sugar,
which can lead to damage of the nerves throughout the body.
 Risks factors of Neuropathy:
1. Non-Modifiable risk factors
a. Increasing age
b. family history of neuropathy
c. Duration of diabtes
d. Male gender
e. tall stature
2. Modifiable Risk factors
a. Smoking
b. Hypertension
c. Obesity
d. Dyslipidemia
e. Excessive alchol
f. Nutritional deficiencies like Vitamin B12

15. FOOT ORTHOSIS IN DIABETES
MANAGEMENT

16. Offloading
The main aim of off-loading, or pressure modulation, is to redistribute
plantar pressures so that there will be a resultant reduction foot
pressures, shock and shear. The various methods of offloading include
bed rest, wheelchair, crutches, total-contact casts, felted foam
dressings, half shoes, therapeutic shoes, padded socks, shoe inserts,
removable cast walkers. Surgical offloading is usually reserved for
chronic deformities or ulcers that are not amenable to conservative
means.
Total Contact Cast (TCC)
TCC is considered the “gold standard” in treating diabetic foot
ulcers. TCC is a method where a non-removable cast is fitted around
and is in contact with the foot and part of the leg. The cast is
commonly applied to a patient lying in prone position with a flexed
knee and the ankles in neutral position to allow for full access to the
sole of the foot. Another advantage of this position is that it allows the
gastrosoleus complex to shift proximally, resulting in better fit of the
cast. After applying a thin dressing to the ulcer, foam padding is
applied to the bony prominences, Achilles tendon and anterior region
of shin to avoid formation of pressure ulcers.

17. Diabetic Socks Diabetic Insoles
Diabetic insoles, often referred to as orthotic
insoles or inserts, are specialized shoe inserts
designed to provide additional support,
cushioning, and pressure distribution for people
with diabetes. These insoles are tailored to the
unique needs of diabetic individuals, focusing
on reducing friction and pressure points that
can lead to ulcers and blisters. The best shoe
insoles for diabetes are made from materials
that offer optimal shock absorption, moisture-
wicking properties, and a comfortable fit.
Diabetic insole treatment involves wearing
these inserts inside your regular shoes. They
work by redistributing weight and relieving
pressure on sensitive areas of the feet,
reducing the risk of foot complications.
Additionally, these insoles can improve gait and
alignment, offering added comfort and stability.

18. References
● https://pixabay.com/images/search/foot%20orthosis/
● https://www.hopkinsmedicine.org/health/conditions-and-diseases/diabetes/diabetic-neuropathy-
nerve-problems
● https://chat.openai.com/c/d4011884-10b0-409d-b538-bd3519da3a04
● https://boynerclinic.com/diabetic-insoles-vs-diabetic-shoes-which-is-right-for-you/