biomechanical offloading - ncvh.org ncvh/5-28-thu/podiatry/1530_lehrman.pdf · •similar to afo...
TRANSCRIPT
Biomechanical Offloading
Jeffrey D Lehrman DPM FACFAS FASPS FAPWH
Fellow American College of Foot amp Ankle Surgeons Fellow American Society of Podiatric Surgeons Fellow Academy of Physicians in Wound Healing Fellow American Academy Podiatric Practice Management Diplomate American Board of Foot amp Ankle Surgery
Disclosures
Speakerrsquos Bureau
bull Smith amp Nephew Advanced Wound Management Division
bull BSN Medical Advanced Wound Care Division
Recurrence and prevention of diabetic foot ulcers after total contact casting
bull 28 patients treated with TCC
bull 85 healed
bull 57 had recurrenceFoot Ankle Int 2007 Jan28(1)64-9
Frigg A1 Pagenstert G Schaumlfer D Valderrabano V Hintermann B
Preventing Recurrance Things to Consider
bull Is the foot quiescent
bull If not need immobilization and optimally NWB
bull What is the plane of the deformity
bull Sagittal plane deformities respond more positively than transverse plane or combinations
Sagittal plane deformity
Transverse plane deformities
Frontal plane deformity
Three Deforming Forces
bull Shearingbull May control with accomodative insoles orthotics and
AFO
bull Bending bull Seen with Equinus
bull May address with heel lift (1 inch)
bull Vertical Load
Preventing Recurrance Things to Consider
Understanding of the Disease Process
Footcare Knowledge
Compliance History
Complexity of the Treatment or Therapy
Beliefs and Perceptions of Benefits
Family Support
Practitioner Reinforcement
Custom Shoe
Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial
bull 171 neuropathic diabetic patients with recently healed plantar foot ulcer
bull Custom-made footwear
bull Recurrence at 18 months
42
Diabetes Care 2013 Dec36(12)4109-16Bus SA1 Waaijman R Arts M de Haart M Busch-Westbroek T van Baal J Nollet F
AFO
AFO
bull Reduces stress to foot and ankle
bull 72-90 more reduction of peak pressure to ulcer sites versus shoes with Plastizote liners
bull Limit mobility in all 3 planes of rearfoot and midfoot
bull Light weight inconspicuous
bull Cant adapt to deformity at foot level
bull Hard plastic
bull Not much help with equinus
Double Upright Brace
Double Upright Brace
bull Similar to AFO but brace is fixed to heel of shoe
bull Still need work inside shoe to accommodate foot deformity
bull Combining 1-inch heel raise and a rocker sole may help to reduce bending forces within the foot during gait
bull This combo disperses mechanical stress
bull Articulation either locked at neutral or
only allows plantarflexion
Double Upright Patellar Bearing Brace
bull More restrictive
bull More difficult to fit
bull Attempts to direct vertical WB forces through the knee
bull More effective at reducing load to the rearfoot
bull Can combine with extra depth custom molded shoes
CROW
CROW
bull Charcot Restraint Orthotic Walker
bull Fuly enclosed AFO with rocker bottom
bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole
bull Attempts to distribute pressure evenly throughout foot and leg
bull Unevenbull Fall riskbull Good fit
TORCH Walker
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
Disclosures
Speakerrsquos Bureau
bull Smith amp Nephew Advanced Wound Management Division
bull BSN Medical Advanced Wound Care Division
Recurrence and prevention of diabetic foot ulcers after total contact casting
bull 28 patients treated with TCC
bull 85 healed
bull 57 had recurrenceFoot Ankle Int 2007 Jan28(1)64-9
Frigg A1 Pagenstert G Schaumlfer D Valderrabano V Hintermann B
Preventing Recurrance Things to Consider
bull Is the foot quiescent
bull If not need immobilization and optimally NWB
bull What is the plane of the deformity
bull Sagittal plane deformities respond more positively than transverse plane or combinations
Sagittal plane deformity
Transverse plane deformities
Frontal plane deformity
Three Deforming Forces
bull Shearingbull May control with accomodative insoles orthotics and
AFO
bull Bending bull Seen with Equinus
bull May address with heel lift (1 inch)
bull Vertical Load
Preventing Recurrance Things to Consider
Understanding of the Disease Process
Footcare Knowledge
Compliance History
Complexity of the Treatment or Therapy
Beliefs and Perceptions of Benefits
Family Support
Practitioner Reinforcement
Custom Shoe
Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial
bull 171 neuropathic diabetic patients with recently healed plantar foot ulcer
bull Custom-made footwear
bull Recurrence at 18 months
42
Diabetes Care 2013 Dec36(12)4109-16Bus SA1 Waaijman R Arts M de Haart M Busch-Westbroek T van Baal J Nollet F
AFO
AFO
bull Reduces stress to foot and ankle
bull 72-90 more reduction of peak pressure to ulcer sites versus shoes with Plastizote liners
bull Limit mobility in all 3 planes of rearfoot and midfoot
bull Light weight inconspicuous
bull Cant adapt to deformity at foot level
bull Hard plastic
bull Not much help with equinus
Double Upright Brace
Double Upright Brace
bull Similar to AFO but brace is fixed to heel of shoe
bull Still need work inside shoe to accommodate foot deformity
bull Combining 1-inch heel raise and a rocker sole may help to reduce bending forces within the foot during gait
bull This combo disperses mechanical stress
bull Articulation either locked at neutral or
only allows plantarflexion
Double Upright Patellar Bearing Brace
bull More restrictive
bull More difficult to fit
bull Attempts to direct vertical WB forces through the knee
bull More effective at reducing load to the rearfoot
bull Can combine with extra depth custom molded shoes
CROW
CROW
bull Charcot Restraint Orthotic Walker
bull Fuly enclosed AFO with rocker bottom
bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole
bull Attempts to distribute pressure evenly throughout foot and leg
bull Unevenbull Fall riskbull Good fit
TORCH Walker
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
Recurrence and prevention of diabetic foot ulcers after total contact casting
bull 28 patients treated with TCC
bull 85 healed
bull 57 had recurrenceFoot Ankle Int 2007 Jan28(1)64-9
Frigg A1 Pagenstert G Schaumlfer D Valderrabano V Hintermann B
Preventing Recurrance Things to Consider
bull Is the foot quiescent
bull If not need immobilization and optimally NWB
bull What is the plane of the deformity
bull Sagittal plane deformities respond more positively than transverse plane or combinations
Sagittal plane deformity
Transverse plane deformities
Frontal plane deformity
Three Deforming Forces
bull Shearingbull May control with accomodative insoles orthotics and
AFO
bull Bending bull Seen with Equinus
bull May address with heel lift (1 inch)
bull Vertical Load
Preventing Recurrance Things to Consider
Understanding of the Disease Process
Footcare Knowledge
Compliance History
Complexity of the Treatment or Therapy
Beliefs and Perceptions of Benefits
Family Support
Practitioner Reinforcement
Custom Shoe
Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial
bull 171 neuropathic diabetic patients with recently healed plantar foot ulcer
bull Custom-made footwear
bull Recurrence at 18 months
42
Diabetes Care 2013 Dec36(12)4109-16Bus SA1 Waaijman R Arts M de Haart M Busch-Westbroek T van Baal J Nollet F
AFO
AFO
bull Reduces stress to foot and ankle
bull 72-90 more reduction of peak pressure to ulcer sites versus shoes with Plastizote liners
bull Limit mobility in all 3 planes of rearfoot and midfoot
bull Light weight inconspicuous
bull Cant adapt to deformity at foot level
bull Hard plastic
bull Not much help with equinus
Double Upright Brace
Double Upright Brace
bull Similar to AFO but brace is fixed to heel of shoe
bull Still need work inside shoe to accommodate foot deformity
bull Combining 1-inch heel raise and a rocker sole may help to reduce bending forces within the foot during gait
bull This combo disperses mechanical stress
bull Articulation either locked at neutral or
only allows plantarflexion
Double Upright Patellar Bearing Brace
bull More restrictive
bull More difficult to fit
bull Attempts to direct vertical WB forces through the knee
bull More effective at reducing load to the rearfoot
bull Can combine with extra depth custom molded shoes
CROW
CROW
bull Charcot Restraint Orthotic Walker
bull Fuly enclosed AFO with rocker bottom
bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole
bull Attempts to distribute pressure evenly throughout foot and leg
bull Unevenbull Fall riskbull Good fit
TORCH Walker
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
Preventing Recurrance Things to Consider
bull Is the foot quiescent
bull If not need immobilization and optimally NWB
bull What is the plane of the deformity
bull Sagittal plane deformities respond more positively than transverse plane or combinations
Sagittal plane deformity
Transverse plane deformities
Frontal plane deformity
Three Deforming Forces
bull Shearingbull May control with accomodative insoles orthotics and
AFO
bull Bending bull Seen with Equinus
bull May address with heel lift (1 inch)
bull Vertical Load
Preventing Recurrance Things to Consider
Understanding of the Disease Process
Footcare Knowledge
Compliance History
Complexity of the Treatment or Therapy
Beliefs and Perceptions of Benefits
Family Support
Practitioner Reinforcement
Custom Shoe
Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial
bull 171 neuropathic diabetic patients with recently healed plantar foot ulcer
bull Custom-made footwear
bull Recurrence at 18 months
42
Diabetes Care 2013 Dec36(12)4109-16Bus SA1 Waaijman R Arts M de Haart M Busch-Westbroek T van Baal J Nollet F
AFO
AFO
bull Reduces stress to foot and ankle
bull 72-90 more reduction of peak pressure to ulcer sites versus shoes with Plastizote liners
bull Limit mobility in all 3 planes of rearfoot and midfoot
bull Light weight inconspicuous
bull Cant adapt to deformity at foot level
bull Hard plastic
bull Not much help with equinus
Double Upright Brace
Double Upright Brace
bull Similar to AFO but brace is fixed to heel of shoe
bull Still need work inside shoe to accommodate foot deformity
bull Combining 1-inch heel raise and a rocker sole may help to reduce bending forces within the foot during gait
bull This combo disperses mechanical stress
bull Articulation either locked at neutral or
only allows plantarflexion
Double Upright Patellar Bearing Brace
bull More restrictive
bull More difficult to fit
bull Attempts to direct vertical WB forces through the knee
bull More effective at reducing load to the rearfoot
bull Can combine with extra depth custom molded shoes
CROW
CROW
bull Charcot Restraint Orthotic Walker
bull Fuly enclosed AFO with rocker bottom
bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole
bull Attempts to distribute pressure evenly throughout foot and leg
bull Unevenbull Fall riskbull Good fit
TORCH Walker
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
Sagittal plane deformity
Transverse plane deformities
Frontal plane deformity
Three Deforming Forces
bull Shearingbull May control with accomodative insoles orthotics and
AFO
bull Bending bull Seen with Equinus
bull May address with heel lift (1 inch)
bull Vertical Load
Preventing Recurrance Things to Consider
Understanding of the Disease Process
Footcare Knowledge
Compliance History
Complexity of the Treatment or Therapy
Beliefs and Perceptions of Benefits
Family Support
Practitioner Reinforcement
Custom Shoe
Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial
bull 171 neuropathic diabetic patients with recently healed plantar foot ulcer
bull Custom-made footwear
bull Recurrence at 18 months
42
Diabetes Care 2013 Dec36(12)4109-16Bus SA1 Waaijman R Arts M de Haart M Busch-Westbroek T van Baal J Nollet F
AFO
AFO
bull Reduces stress to foot and ankle
bull 72-90 more reduction of peak pressure to ulcer sites versus shoes with Plastizote liners
bull Limit mobility in all 3 planes of rearfoot and midfoot
bull Light weight inconspicuous
bull Cant adapt to deformity at foot level
bull Hard plastic
bull Not much help with equinus
Double Upright Brace
Double Upright Brace
bull Similar to AFO but brace is fixed to heel of shoe
bull Still need work inside shoe to accommodate foot deformity
bull Combining 1-inch heel raise and a rocker sole may help to reduce bending forces within the foot during gait
bull This combo disperses mechanical stress
bull Articulation either locked at neutral or
only allows plantarflexion
Double Upright Patellar Bearing Brace
bull More restrictive
bull More difficult to fit
bull Attempts to direct vertical WB forces through the knee
bull More effective at reducing load to the rearfoot
bull Can combine with extra depth custom molded shoes
CROW
CROW
bull Charcot Restraint Orthotic Walker
bull Fuly enclosed AFO with rocker bottom
bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole
bull Attempts to distribute pressure evenly throughout foot and leg
bull Unevenbull Fall riskbull Good fit
TORCH Walker
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
Transverse plane deformities
Frontal plane deformity
Three Deforming Forces
bull Shearingbull May control with accomodative insoles orthotics and
AFO
bull Bending bull Seen with Equinus
bull May address with heel lift (1 inch)
bull Vertical Load
Preventing Recurrance Things to Consider
Understanding of the Disease Process
Footcare Knowledge
Compliance History
Complexity of the Treatment or Therapy
Beliefs and Perceptions of Benefits
Family Support
Practitioner Reinforcement
Custom Shoe
Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial
bull 171 neuropathic diabetic patients with recently healed plantar foot ulcer
bull Custom-made footwear
bull Recurrence at 18 months
42
Diabetes Care 2013 Dec36(12)4109-16Bus SA1 Waaijman R Arts M de Haart M Busch-Westbroek T van Baal J Nollet F
AFO
AFO
bull Reduces stress to foot and ankle
bull 72-90 more reduction of peak pressure to ulcer sites versus shoes with Plastizote liners
bull Limit mobility in all 3 planes of rearfoot and midfoot
bull Light weight inconspicuous
bull Cant adapt to deformity at foot level
bull Hard plastic
bull Not much help with equinus
Double Upright Brace
Double Upright Brace
bull Similar to AFO but brace is fixed to heel of shoe
bull Still need work inside shoe to accommodate foot deformity
bull Combining 1-inch heel raise and a rocker sole may help to reduce bending forces within the foot during gait
bull This combo disperses mechanical stress
bull Articulation either locked at neutral or
only allows plantarflexion
Double Upright Patellar Bearing Brace
bull More restrictive
bull More difficult to fit
bull Attempts to direct vertical WB forces through the knee
bull More effective at reducing load to the rearfoot
bull Can combine with extra depth custom molded shoes
CROW
CROW
bull Charcot Restraint Orthotic Walker
bull Fuly enclosed AFO with rocker bottom
bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole
bull Attempts to distribute pressure evenly throughout foot and leg
bull Unevenbull Fall riskbull Good fit
TORCH Walker
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
Frontal plane deformity
Three Deforming Forces
bull Shearingbull May control with accomodative insoles orthotics and
AFO
bull Bending bull Seen with Equinus
bull May address with heel lift (1 inch)
bull Vertical Load
Preventing Recurrance Things to Consider
Understanding of the Disease Process
Footcare Knowledge
Compliance History
Complexity of the Treatment or Therapy
Beliefs and Perceptions of Benefits
Family Support
Practitioner Reinforcement
Custom Shoe
Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial
bull 171 neuropathic diabetic patients with recently healed plantar foot ulcer
bull Custom-made footwear
bull Recurrence at 18 months
42
Diabetes Care 2013 Dec36(12)4109-16Bus SA1 Waaijman R Arts M de Haart M Busch-Westbroek T van Baal J Nollet F
AFO
AFO
bull Reduces stress to foot and ankle
bull 72-90 more reduction of peak pressure to ulcer sites versus shoes with Plastizote liners
bull Limit mobility in all 3 planes of rearfoot and midfoot
bull Light weight inconspicuous
bull Cant adapt to deformity at foot level
bull Hard plastic
bull Not much help with equinus
Double Upright Brace
Double Upright Brace
bull Similar to AFO but brace is fixed to heel of shoe
bull Still need work inside shoe to accommodate foot deformity
bull Combining 1-inch heel raise and a rocker sole may help to reduce bending forces within the foot during gait
bull This combo disperses mechanical stress
bull Articulation either locked at neutral or
only allows plantarflexion
Double Upright Patellar Bearing Brace
bull More restrictive
bull More difficult to fit
bull Attempts to direct vertical WB forces through the knee
bull More effective at reducing load to the rearfoot
bull Can combine with extra depth custom molded shoes
CROW
CROW
bull Charcot Restraint Orthotic Walker
bull Fuly enclosed AFO with rocker bottom
bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole
bull Attempts to distribute pressure evenly throughout foot and leg
bull Unevenbull Fall riskbull Good fit
TORCH Walker
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
Three Deforming Forces
bull Shearingbull May control with accomodative insoles orthotics and
AFO
bull Bending bull Seen with Equinus
bull May address with heel lift (1 inch)
bull Vertical Load
Preventing Recurrance Things to Consider
Understanding of the Disease Process
Footcare Knowledge
Compliance History
Complexity of the Treatment or Therapy
Beliefs and Perceptions of Benefits
Family Support
Practitioner Reinforcement
Custom Shoe
Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial
bull 171 neuropathic diabetic patients with recently healed plantar foot ulcer
bull Custom-made footwear
bull Recurrence at 18 months
42
Diabetes Care 2013 Dec36(12)4109-16Bus SA1 Waaijman R Arts M de Haart M Busch-Westbroek T van Baal J Nollet F
AFO
AFO
bull Reduces stress to foot and ankle
bull 72-90 more reduction of peak pressure to ulcer sites versus shoes with Plastizote liners
bull Limit mobility in all 3 planes of rearfoot and midfoot
bull Light weight inconspicuous
bull Cant adapt to deformity at foot level
bull Hard plastic
bull Not much help with equinus
Double Upright Brace
Double Upright Brace
bull Similar to AFO but brace is fixed to heel of shoe
bull Still need work inside shoe to accommodate foot deformity
bull Combining 1-inch heel raise and a rocker sole may help to reduce bending forces within the foot during gait
bull This combo disperses mechanical stress
bull Articulation either locked at neutral or
only allows plantarflexion
Double Upright Patellar Bearing Brace
bull More restrictive
bull More difficult to fit
bull Attempts to direct vertical WB forces through the knee
bull More effective at reducing load to the rearfoot
bull Can combine with extra depth custom molded shoes
CROW
CROW
bull Charcot Restraint Orthotic Walker
bull Fuly enclosed AFO with rocker bottom
bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole
bull Attempts to distribute pressure evenly throughout foot and leg
bull Unevenbull Fall riskbull Good fit
TORCH Walker
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
Preventing Recurrance Things to Consider
Understanding of the Disease Process
Footcare Knowledge
Compliance History
Complexity of the Treatment or Therapy
Beliefs and Perceptions of Benefits
Family Support
Practitioner Reinforcement
Custom Shoe
Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial
bull 171 neuropathic diabetic patients with recently healed plantar foot ulcer
bull Custom-made footwear
bull Recurrence at 18 months
42
Diabetes Care 2013 Dec36(12)4109-16Bus SA1 Waaijman R Arts M de Haart M Busch-Westbroek T van Baal J Nollet F
AFO
AFO
bull Reduces stress to foot and ankle
bull 72-90 more reduction of peak pressure to ulcer sites versus shoes with Plastizote liners
bull Limit mobility in all 3 planes of rearfoot and midfoot
bull Light weight inconspicuous
bull Cant adapt to deformity at foot level
bull Hard plastic
bull Not much help with equinus
Double Upright Brace
Double Upright Brace
bull Similar to AFO but brace is fixed to heel of shoe
bull Still need work inside shoe to accommodate foot deformity
bull Combining 1-inch heel raise and a rocker sole may help to reduce bending forces within the foot during gait
bull This combo disperses mechanical stress
bull Articulation either locked at neutral or
only allows plantarflexion
Double Upright Patellar Bearing Brace
bull More restrictive
bull More difficult to fit
bull Attempts to direct vertical WB forces through the knee
bull More effective at reducing load to the rearfoot
bull Can combine with extra depth custom molded shoes
CROW
CROW
bull Charcot Restraint Orthotic Walker
bull Fuly enclosed AFO with rocker bottom
bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole
bull Attempts to distribute pressure evenly throughout foot and leg
bull Unevenbull Fall riskbull Good fit
TORCH Walker
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
Custom Shoe
Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial
bull 171 neuropathic diabetic patients with recently healed plantar foot ulcer
bull Custom-made footwear
bull Recurrence at 18 months
42
Diabetes Care 2013 Dec36(12)4109-16Bus SA1 Waaijman R Arts M de Haart M Busch-Westbroek T van Baal J Nollet F
AFO
AFO
bull Reduces stress to foot and ankle
bull 72-90 more reduction of peak pressure to ulcer sites versus shoes with Plastizote liners
bull Limit mobility in all 3 planes of rearfoot and midfoot
bull Light weight inconspicuous
bull Cant adapt to deformity at foot level
bull Hard plastic
bull Not much help with equinus
Double Upright Brace
Double Upright Brace
bull Similar to AFO but brace is fixed to heel of shoe
bull Still need work inside shoe to accommodate foot deformity
bull Combining 1-inch heel raise and a rocker sole may help to reduce bending forces within the foot during gait
bull This combo disperses mechanical stress
bull Articulation either locked at neutral or
only allows plantarflexion
Double Upright Patellar Bearing Brace
bull More restrictive
bull More difficult to fit
bull Attempts to direct vertical WB forces through the knee
bull More effective at reducing load to the rearfoot
bull Can combine with extra depth custom molded shoes
CROW
CROW
bull Charcot Restraint Orthotic Walker
bull Fuly enclosed AFO with rocker bottom
bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole
bull Attempts to distribute pressure evenly throughout foot and leg
bull Unevenbull Fall riskbull Good fit
TORCH Walker
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial
bull 171 neuropathic diabetic patients with recently healed plantar foot ulcer
bull Custom-made footwear
bull Recurrence at 18 months
42
Diabetes Care 2013 Dec36(12)4109-16Bus SA1 Waaijman R Arts M de Haart M Busch-Westbroek T van Baal J Nollet F
AFO
AFO
bull Reduces stress to foot and ankle
bull 72-90 more reduction of peak pressure to ulcer sites versus shoes with Plastizote liners
bull Limit mobility in all 3 planes of rearfoot and midfoot
bull Light weight inconspicuous
bull Cant adapt to deformity at foot level
bull Hard plastic
bull Not much help with equinus
Double Upright Brace
Double Upright Brace
bull Similar to AFO but brace is fixed to heel of shoe
bull Still need work inside shoe to accommodate foot deformity
bull Combining 1-inch heel raise and a rocker sole may help to reduce bending forces within the foot during gait
bull This combo disperses mechanical stress
bull Articulation either locked at neutral or
only allows plantarflexion
Double Upright Patellar Bearing Brace
bull More restrictive
bull More difficult to fit
bull Attempts to direct vertical WB forces through the knee
bull More effective at reducing load to the rearfoot
bull Can combine with extra depth custom molded shoes
CROW
CROW
bull Charcot Restraint Orthotic Walker
bull Fuly enclosed AFO with rocker bottom
bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole
bull Attempts to distribute pressure evenly throughout foot and leg
bull Unevenbull Fall riskbull Good fit
TORCH Walker
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
AFO
AFO
bull Reduces stress to foot and ankle
bull 72-90 more reduction of peak pressure to ulcer sites versus shoes with Plastizote liners
bull Limit mobility in all 3 planes of rearfoot and midfoot
bull Light weight inconspicuous
bull Cant adapt to deformity at foot level
bull Hard plastic
bull Not much help with equinus
Double Upright Brace
Double Upright Brace
bull Similar to AFO but brace is fixed to heel of shoe
bull Still need work inside shoe to accommodate foot deformity
bull Combining 1-inch heel raise and a rocker sole may help to reduce bending forces within the foot during gait
bull This combo disperses mechanical stress
bull Articulation either locked at neutral or
only allows plantarflexion
Double Upright Patellar Bearing Brace
bull More restrictive
bull More difficult to fit
bull Attempts to direct vertical WB forces through the knee
bull More effective at reducing load to the rearfoot
bull Can combine with extra depth custom molded shoes
CROW
CROW
bull Charcot Restraint Orthotic Walker
bull Fuly enclosed AFO with rocker bottom
bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole
bull Attempts to distribute pressure evenly throughout foot and leg
bull Unevenbull Fall riskbull Good fit
TORCH Walker
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
AFO
bull Reduces stress to foot and ankle
bull 72-90 more reduction of peak pressure to ulcer sites versus shoes with Plastizote liners
bull Limit mobility in all 3 planes of rearfoot and midfoot
bull Light weight inconspicuous
bull Cant adapt to deformity at foot level
bull Hard plastic
bull Not much help with equinus
Double Upright Brace
Double Upright Brace
bull Similar to AFO but brace is fixed to heel of shoe
bull Still need work inside shoe to accommodate foot deformity
bull Combining 1-inch heel raise and a rocker sole may help to reduce bending forces within the foot during gait
bull This combo disperses mechanical stress
bull Articulation either locked at neutral or
only allows plantarflexion
Double Upright Patellar Bearing Brace
bull More restrictive
bull More difficult to fit
bull Attempts to direct vertical WB forces through the knee
bull More effective at reducing load to the rearfoot
bull Can combine with extra depth custom molded shoes
CROW
CROW
bull Charcot Restraint Orthotic Walker
bull Fuly enclosed AFO with rocker bottom
bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole
bull Attempts to distribute pressure evenly throughout foot and leg
bull Unevenbull Fall riskbull Good fit
TORCH Walker
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
Double Upright Brace
Double Upright Brace
bull Similar to AFO but brace is fixed to heel of shoe
bull Still need work inside shoe to accommodate foot deformity
bull Combining 1-inch heel raise and a rocker sole may help to reduce bending forces within the foot during gait
bull This combo disperses mechanical stress
bull Articulation either locked at neutral or
only allows plantarflexion
Double Upright Patellar Bearing Brace
bull More restrictive
bull More difficult to fit
bull Attempts to direct vertical WB forces through the knee
bull More effective at reducing load to the rearfoot
bull Can combine with extra depth custom molded shoes
CROW
CROW
bull Charcot Restraint Orthotic Walker
bull Fuly enclosed AFO with rocker bottom
bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole
bull Attempts to distribute pressure evenly throughout foot and leg
bull Unevenbull Fall riskbull Good fit
TORCH Walker
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
Double Upright Brace
bull Similar to AFO but brace is fixed to heel of shoe
bull Still need work inside shoe to accommodate foot deformity
bull Combining 1-inch heel raise and a rocker sole may help to reduce bending forces within the foot during gait
bull This combo disperses mechanical stress
bull Articulation either locked at neutral or
only allows plantarflexion
Double Upright Patellar Bearing Brace
bull More restrictive
bull More difficult to fit
bull Attempts to direct vertical WB forces through the knee
bull More effective at reducing load to the rearfoot
bull Can combine with extra depth custom molded shoes
CROW
CROW
bull Charcot Restraint Orthotic Walker
bull Fuly enclosed AFO with rocker bottom
bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole
bull Attempts to distribute pressure evenly throughout foot and leg
bull Unevenbull Fall riskbull Good fit
TORCH Walker
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
Double Upright Patellar Bearing Brace
bull More restrictive
bull More difficult to fit
bull Attempts to direct vertical WB forces through the knee
bull More effective at reducing load to the rearfoot
bull Can combine with extra depth custom molded shoes
CROW
CROW
bull Charcot Restraint Orthotic Walker
bull Fuly enclosed AFO with rocker bottom
bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole
bull Attempts to distribute pressure evenly throughout foot and leg
bull Unevenbull Fall riskbull Good fit
TORCH Walker
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
CROW
CROW
bull Charcot Restraint Orthotic Walker
bull Fuly enclosed AFO with rocker bottom
bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole
bull Attempts to distribute pressure evenly throughout foot and leg
bull Unevenbull Fall riskbull Good fit
TORCH Walker
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
CROW
bull Charcot Restraint Orthotic Walker
bull Fuly enclosed AFO with rocker bottom
bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole
bull Attempts to distribute pressure evenly throughout foot and leg
bull Unevenbull Fall riskbull Good fit
TORCH Walker
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
TORCH Walker
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
TORCH Walker
bull Total contact Orthotic Restraining Custom Hybrid
bull Custom Insert
bull Rocker Bottom
bull Integrated solid AFO
bull Adjustable for edema
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
Ambulatory AidesOften Forgotten Addition to Offloading Devices
bull Cane - Increases base of support No off-loading
bull Crutches - NWB to PWBbull REALISTICbull SAFE
bull Walker - Greater stability NWB to PWB
bull Wheel Chair
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
A stretching program can significantly reduce peak plantar pressures in diabetic subjects
Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002
The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
Gait Alterations in Diabetes
bull Individuals with diabetes
bull slower
bull shorter step lengths
bull longer stance phase
bull wider base of support
bull greater step time variability on irregular surfaces
bull improper pressure distribution
bull decreased ankle mobility ankle moment and ankle power during walking
Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait
Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash
1374
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
Gait Modifications We Can Teach to Reduce Plantar Pressures
Lengthen stride
Faster cadence
Alter foot placement
More Propulsive
Hip strategyDiabetic gait With improved
stride length
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
Smart Sox
bull Socks with fiber-optics that can measure temperature pressure
bull Communicate that information via bluetooth or wifi to smart phone or doctor
bull ldquoPrescribe activityrdquo
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
Closing Remarks Thank You
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
References
bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31
bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57
References
bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS
bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135
bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57