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Therapeutic Footwear for Diabetic Feet
The answer is yes. These are protective footwear for patients who have decreased foot sensations secondary to diabetic Neuropathy. These patients have abnormally high pressures under their feet making them susceptible to foot ulceration. These high pressure areas have to be reduced to prevent further risk and damage to the foot. One of the possible solutions is to use protective or therapeutic footwear consisting of custom designed shoes or custom made inserts. These inserts generally incorporate force redistributing features. Prescription of footwear depends on which risk category the patient falls in to
Risk category 0: are patients that have intact sensation in their foot, with absence of foot deformities and no history of planter ulceration. These patients do not need special therapeutic footwear and can wear “off the shelf” general purpose comfort footwear
Risk category 1: patients would have lost the intact sensation in their feet. Although there would be no foot deformities nor any history of plantar ulceration. These patients need footwear as shown in the figure below :
- Covering to prevent injury from heat.
- Rigidity of base – to reduce the effect of shearing stress, to stabilize the foot and correct mobile deformity.
- Moulding to increase the weight bearing area and to take weight off the affected area.
Risk category 2: These patients have decreased sensations and also show presence of foot deformities. They must be recommended special footwear with extra depth, soles for better accommodation of deformity as well as for providing for an orthosis.
Rocker sole with use of shank is advisable to prevent footwear from bending and also to limit toe and mid foot motion. Cushioned heels and Velcro closure may also be indicated.
Risk category 3: There high risk diabetic foot patients have decreased sensation, with or without deformities with previous ulceration and decreased lower limb blood supply. Customized footwear to accommodate the foot and relief from pressure is advised.
These protective footwear will help prevention of ulceration and amputation. When you visit your doctor, ask for the foot tests to find out which category your fall into, so that appropriate footwear can be advised.
Cherish your feet. “Thy feet thy fortune”
Diabetes is now a household term and diabetic foot is a well-known and well described entity. While prevention is the key to keep the feet healthy and safe, a multitude of problems can plague the foot crippling the person who is in most need of locomotion and exercise. These include redness and swelling (cellulitis), diabetic nail infections, minor ulcerations between the toes, major ulcers at the pressure areas of the foot.
These problems may need multiple visits to the diabetologist and the diabetic foot surgeon until the wound reaches a stable state where there is no presence of infection or dead tissue. Achieving total healing of the wound is a delicate balance of good foot care, offloading the pressure from the foot and blood sugar level control and may take a long time. To reduce the burden of costs and time for both patient and doctor a few dressing methods can be recommended for home care:
Concepts of wound care have changed over time with increasing understanding of wound biology and behaviour. The old school thought of “leave it open to air to heal” doesn't apply anymore and has proved to be more harmful for healing. The new mantra is to “cover the wound and keep it moist” to hasten healing.
Here are a few handy stepwise tips:
1) Inspect your bandages regularly: If the bandage is showing soakage of wound fluid or emanating smell, it's time to change it. A soaked bandage is an open invitation to bacteria.2) Wound wash: It is no longer recommended to wash the wound with agents like concentrated betadine or hydrogen peroxide solutions. These can do more harm than good for the delicate new healing cells. Adequate wash with normal saline or RO water is now the preferred method of choice for cleansing wounds. The washed wound is then dabbed dry to remove excess moisture from the surrounding areas.
3) Gels and Ointments: The local application prescribed by the treating doctor is then applied to the wound wearing sterile gloves. Local applications commonly prescribed to promote moist wound healing include silver ion containing gels like hydroheal, megaheal etc. Other ointments commonly used target skin infection specific organisms (T. Bact, Fucidin).
4) Non adherent layer: Whenever possible the wound should be covered first by a layer of dressing which is non sticky while removing. This prevents bleeding and injury to healing cells during dressing change. This is possible by using dressing materials which have paraffin in them which makes them non sticky (bactigras, jelonet, cuticell, etc.)
5) Absorbing layers: Next the wound is covered with layers of sterile gauze piece which can soak up wound secretions.
6) Bandaging: Bandaging a diabetic foot wound with a cotton or crepe bandage is a delicate balance between tying it loose enough to allow circulation but not so loose that the dressing comes off on movement.
Certain things have to be always borne in mind while caring for diabetic feet:
- I. Ensure the feet are dry between the toes before giving a dressing
- II. If needed a dusting powder like candid can be used to prevent fungal infections
- III. Usage of socks and covered footwear is recommended even at home
- IV. Lastly always offload your foot as recommended by the surgeon by using either customised footwear, walkers or crutches
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