DIABETES MELLITUS

CORRECT FOOTWEAR FOR GRADE 1 FOOT

PRESENTED BY KSRS.PRASAD

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.

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

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

CORRECT DIABETIC FOOTWEAR CONSIDERATIONS

• THE SOLE• THE INSOLE• THE UPPER• THE DESIGNS• MAKING PRINCIPLES• FITTING PROCEDURE• FOOTWEAR CARE/ FOOTWEAR ORTHOTIC

MODIFICATIONS

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

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)

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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)

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

THANK YOU

YOURS IN FOOTCARE ALWAYS COMMITTED TO DIABETIC FOOTCARE