The document discusses considerations for proper footwear for patients with grade 1 diabetic foot disease. It emphasizes the importance of therapeutic footwear that accommodates, cushions, and stabilizes the foot to prevent ulcers. Key aspects of footwear design discussed include a rigid sole, broad and tough sole, low heel, soft and breathable uppers, and an insole that provides total contact with the foot. Proper fitting and regular inspection of footwear is also highlighted as important for preventing foot problems in diabetic patients.
2. 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%
& OUR OWN APPROPRIATE BACKGROUND AND COMMITMENT
TO THE CAUSE AND TO THE MEDICAL FRATERNITY
TOROUGHLY SUPPORTED BY OUR VAST AND CONTINUING
RESEARCH EXPERIENCE AND EXPERTISE.
3. 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
4. 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
5. CORRECT DIABETIC FOOTWEAR
CONSIDERATIONS
• THE SOLE
• THE INSOLE
• THE UPPER
• THE DESIGNS
• MAKING PRINCIPLES
• FITTING PROCEDURE
• FOOTWEAR CARE/ FOOTWEAR ORTHOTIC
MODIFICATIONS
6. 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
7. 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)
8. 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
9. 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
10. 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
11. 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.
12. 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
13. 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
14. 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
15. 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
16. 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
17. 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
18. 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
19. 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
20. 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
21. 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
22. 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
23. 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
24. 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)
25. 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