- See:
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Charcot Changes in the Diabetic Patient:
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Diabetic Foot Menu:
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Pedorthic Footwear Association
- Discussion:
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foot orthotics:
- any diabetic patient who lacks protective sensation should have aggressive protective foot care;
- diabetic foot should be protected by a padded foot cradle, & foot position should be turned frequently to prevent pressure ulcers;
- plastazote inserts is useful for diabetics w/ several bony prominences;
- material is easy to mold and is fairly inexpensive; however, it tend to bottom out, requiring new orthosis w/in 3-6 months;
- insoles should always be soft, but the material nearest the skin should be especially soft;
- recently it has observed that simple running shoes can predictably reduce plantar pressures in diabetic patients by 30%;
- in contrast, tight leather Oxford shoes do little to reduce plantar pressure;
- likewise, combination of padded socks and debridement of hyperkeratotic tissue may result in decreases of plantar pressure by 30%;
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Charcot Restraint Orthotic Walker:
- refers to a clam shell AFO which has the following characteristics:
- cast is made of the foot and ankle for a customized shell;
- mold is lined with perforated Plastazote (provides cushioning and ventilation);
- plantar surface of foot is lined with PPT which is a shock absorbing innersole which is removable;
- a rocker bottom sole facilitates gait (consider using lightweight EVA material);
- anterior and posterior shells are made with reinforced carbon fiber for strength;
- ref: Charcot restraint orthotic walker.
JA Mehta et al.
Foot and Ankle International. Vol 19. No 9. Sept 1998. p 619.
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debridement of ulcers;
- combination of padded socks and debridement of hyperkeratotic tissue may result in decreases of plantar pressure by 30%;
- hypertrophic ulcers should be debrided back to healthy skin margins over several office visits;
The Use of Running Shoes to Reduce Plantar Pressures in Patients Who Have Diabetes.
J.E. Perry et al. JBJS Vol. 77-A. No. 12. Dec 1995.
Objective evaluation of insert material for diabetic and athletic footwear.
Kourosh S, Stills M, Mooney J:
Foot Ankle 1988;3:11-116.
A technique for treatment of chronic plantar ulcer by saucerization and primary closure.
Leventen EO:
Charcot foot: Foot Ankle 1985;6:295-299.
The total-contact cast for management of neuropathic plantar ulceration of the foot.
Fractures associated with neuropathic arthroplasty in adults who have juvenile diabetes.
Thompson RC:
J Bone Joint Surg (Am) 1988;70A:1192.
The diabetic foot: evolving technologies.
The effect of callus removal on dynamic plantar foot pressures in diabetic patients.
MJ Young et al.
Diabetic Medicine. Vol 9. 1992. p 55-57.
