Orthotic management of diabetes mellitus foot

Orthotic management of diabetic foot.

1. PRESENTED BY- RANI KUMARI MPO - 1 st year AIIPMR MUMBAI Orthotic Management for Diabetes Mellitus patients

2. What is diabetes mellitus Sign and symptoms of diabetic mellitus Types of diabetic mellitus Grade of diabetic mellitus Cause of diabetic mellitus Orthotic management of diabetic mellitus How to control the diabetes Complication of diabetic foot

3. Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Diabetic foot is defined as any foot pathology that results directly from diabetes or its long term complications Two types of diabetes: type I and type II diabetes 1.Diabetic mellitus

4. Diabetes Ratio in India India is home to 50 million people with diabetes, Projections show that this will increase to 70 million in 2025.  With the largest number of diabetic patients, India leads the “Diabetes Capital of the World”. Between 5% and 10% of the nation's health budget is spent on the prevention and treatment of diabetes. In India, diabetes is no longer a disease of the affluent or a rich man's disease.

5. 3.Types of diabetes…

6. Type 1 diabetes mellitus: R esults from the body's failure to produce sufficient insulin. Type 2 diabetes mellitus: R esults from resistance to the insulin, often initially with normal or increased levels of circulating insulin. Gestational diabetes : Pregnant women who have never had diabetes before but who have high blood glucose levels during pregnancy are said to have gestational diabetes. Gestational diabetes affects about 4% of all pregnant women. Maturity-onset diabetes of the young (MODY ) includes several forms of diabetes with monogenetic defects of beta-cell function, usually manifesting as mild hyperglycemia at a young age, and usually inherited in an autosomal-dominant manner. Types of diabetes-

7. 5.Causes of diabetes

8. Eat three meals a day. Reduce the fat in the diet, especially saturated fats. Use unsaturated fats or oils, especially monounsaturated fats, eg - olive oil and rapeseed oil. Eat more fruit and vegetables. Aim for at least five portions a day . Limit sugar and sugary foods. Reduce salt in the diet to 6 g or less per day . Diabetes Diet and Exercise

9. Preventative foot care Diabetic foot ulcer (DFU) care Ischemia management Neuropathy management Surgery After surgery (amputation ) prosthetic management can be use… 6. Management

10. Fore-foot deformity - 1 .Claw toes 2. Hammer toe 3. Crowding of toes. 4. Cock-up deformity in great toe 5. Varus deformity of toes 6.Hallux Valgus Mid-foot deformity- 1. Midsole Ulcer 2.Charcot foot Hind-foot deformity- 1. Ulcer 2.Gangrene Common foot deformities in diabetic mellitus

11. Crowding of toe Hammer toe Claw toe Hallux valgus

12. Diabetic foot ulcers are sores on the feet that occur in 15% of diabetic patients some time during their lifetime. The risk of lower-extremity amputation is increased 8-fold in these patients once an ulcer develops . Foot ulcers are a common complication of diabetes. They are most prevalent under your big toes as well as the balls of your feet. Ulcers form as a result of skin tissue breaking down and exposing underlying layers. These sores can affect your feet down to the bones. All diabetes patients are at risk for developing foot ulcers and foot pain . If neglected, infected ulcers may result in amputation. Treatment for diabetic foot ulcers and foot pain varies depending on their causes. Diabetic foot ulcer

13. What causes diabetic foot ulcers? The most common causes of diabetic ulcers include: poor circulation high blood sugar (hyperglycemia) nerve damage irritated or wounded feet Poor blood circulation is a form of vascular disease in which blood doesn’t flow to your feet effectively. It’s just one cause of foot ulcers. Poor circulation can also make it more difficult for ulcers to heal. High glucose levels can slow down the healing process of an infected foot ulcer. This makes blood sugar management critical. People with type 2 diabetes tend to have a harder time fighting off infections from ulcers..

14. Wagner classification- Grade 1 - Skin intact, no foot deformity Grade 2 - Superficial ulcer Grade 3 - Deep ulcer with infection Grade 4 - Limited necrosis Grade 5 - Necrosis of the entire foot 4.Classification of ulcer-

15. Grade -1 Grade-2 Grade-3

16. Grade -4 Grade -5

17. Treatment according to U lcer Grade- Wagner 1-2 Total contact cast Distributes pressure and allows patients to continue ambulation Principles of application Changes, Padding, removal Antibiotics if infected Wagner 3 Excision of infected bone Wound allowed to granulate Grafting (skin or bone) not generally effective Wagner 4-5 Amputation ? level

18. This is referred to as off-loading. It’s helpful for all forms of diabetic foot ulcers. Pressure from walking can worsen an infection and make an ulcer expand. D octor may recommend wearing certain items to protect your feet: D iabetic shoes Total contact casts F oot braces C ompression wraps S hoe inserts Toe socks Diabetics socks Treating Diabetic Foot Ulcers Othotic Management

19. If you are in the early stages of diabetes, and have no history of foot problems or any loss of sensation, a properly fitting shoe made of soft materials with a shock absorbing sole may be all that you need. It is also important for patients to learn how to select the right type of shoe in the right size, so that future problems can be prevented. The excessive pressure and friction from the wrong kind of shoes or from poorly fitting shoes can lead to blisters, calluses and ulcers, not only in the insensitive foot but also in feet with no evidence of neuropathy . 1.Diabetic shoes

20. Many patients with diabetes need special footwear prescribed by a physician. Prescription footwear for patients with diabetes includes--- Healing shoes - Immediately following surgery or ulcer treatment, some type of shoe may be necessary before a regular shoe can be worn. These include custom sandals (open toe), heat-moldable healing shoes (closed toe), and post-operative shoes. Prescription footwear

21. Cont … In-depth shoes. The in-depth shoe is the basis for most footwear prescriptions. It is generally an oxford-type or athletic shoe with an additional 1/4- to 1/2-inch of depth throughout the shoe, allowing extra volume to accommodate any needed inserts or orthosis , as well as deformities commonly associated with a Diabetic foot. In-depth shoes also tend to be light in weight, have shock-absorbing soles, and come in a wide range of shapes and sizes to accommodate virtually any foot

22. External shoe modifications- This involves modifying the outside of the shoe in some way, such as modifying the shape of the sole or adding shock-absorbing or stabilizing materials relief.

23. Custom-made shoes- When extremely severe deformities are present, a custom-made shoe can be constructed from a cast or model of the patient's foot. These cases are rare. With extensive modifications of in-depth shoes, even the most severe deformities can usually be accommodated Cont..

24. The "total contact cast" is a casting technique that is used to heal diabetic foot ulcers and to protect the foot during the early phases of Charcot fracture dislocations. The cast is used to heal diabetic foot ulcers by distributing weight along the entire plantar aspect (sole) of the foot. It is applied in such a way to intimately contact the exact contour of the foot; hence, the designation "total contact cast." By relieving the pressure on the prominent areas of the foot, the ulcers are permitted to heal if the cast is applied in such a way that the patient can remain ambulatory during the treatment of the ulcer.  2.Total contact cast

25. Charcot foot   is a condition causing weakening of the bones in the  foot  that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking the  foot  eventually changes shape . For the Charcot foot, the total contact cast is used in two ways. In the initial treatment of the Charcot foot when the breakdown is occurring. T he foot is quite swollen and reactive, the cast is applied to control the movement of the foot and support its contours.

26. 3. Diabetic foot brace Diabetic brace

27. Removable cast walkers and the “instant” total contact cast.  The removable cast walker (RCW) offers several potential advantages over traditional TCC. Removable walkers are , easily removed for self-inspection of the wound and application of topical therapies that require frequent administration. Patients can bath and sleep more comfortably when wearing these devices, and, because they are removable, RCWs can be used with infected wounds.    1 . Removable cast walkers

28. 2 .Scotchcast boot. The Scotchcast boot is an alternative plaster of Paris cast, developed when fiberglass materials were introduced. As a substitute for plaster of Paris, Scotchcast is much lighter with high integral strength . The basic functions of the cast are to reduce the pressure on the lesion, maintain patient mobility, and protect the remaining foot.    The Scotchcast boot is a well-padded cast cut away by the ankle and made either removable or non removable by cutting away the cast over the dorsum of the foot. A closure is made, consisting of padding and tape with fabric hook–and-loop fastener straps. Windows are cut over the ulcers as needed, and a removable heel cap of fiberglass is added for large heel ulcers. The boot is worn with a cast sandal to increase patient mobility, keeping the patient ambulatory while protecting the ulcer from any pressure.

29. 3 .   Half shoes . Originally designed to decrease pressure on the forefoot postoperatively, the half shoe has become quite popular for treating foot wounds in people with diabetes. These devices are inexpensive and easy to apply.

30. 4.CROW The  Charcot Restraint Orthotic Walker or CROW for short is a type of custom made brace that is designed to reduce pressure on the foot and the ankle for people who have a neuropathic ulcer and/or a Charcot Joint. The CROW is made from a cast or impression of the foot and lower leg and is designed with a soft foot bed and cushioned liner. The brace is made of rigid plastic with a rockered bottom to allow for normal heel to toe walking. The brace works to reduce destructive forces in the foot and ankle, protecting the bone at the same time as reducing pressure on the bottom of the foot to help heel and prevent ulcers.

31. Layered compression therapy for venous leg ulcers and ulcers associated with chronic leg edema has been shown to be an effective treatment in patients with adequate arterial circulation . Layered compression therapy was an effective and safe treatment in this diabetic population with adequate arterial circulation. Reduced compression also can be helpful in some patients with arterial compromise . 4.Compressive wrap

32. . They are always applying pressure to your arm or legs, whether you’re sitting, standing or laying down. Alternative compression garments provide a different type of compression which is dynamic. This means they only provide compression when your muscles push against them. Dynamic compression is more comfortable to wear when you are resting, and can be worn for longer periods of time, up to 24 hours a day if necessary.

33. 5.Shoe insert An orthosis is a removable insole which provides pressure relief and shock absorption. Both pre-made and custom-made orthosis or inserts are commonly prescribed for patients with diabetes, including a special "total contact orthosis ," which is made from a model of your foot and offers a high level of comfort and pressure.

34. People with diabetes have to be especially careful with their feet, as decreased circulation and other diabetes-related conditions could affect overall foot health. People with diabetes are less likely to notice foot damage, such as a blister or cut. Patients with diabetes can also get common foot problems that others do but, when left untreated, it can possibly lead to infection and serious complications. Cont …

35. 6.Socks for diabetics

36. Management of ischemic diabetic foot.

37. Management for Neuropathic diabetes

38. Indications for amputation Uncontrollable infection Inability to obtain a plantar grade, dry foot that can tolerate weight bearing Non ambulatory patient Surgery