Diabetic Foot Management

Peripheral neuropathy is considered to be one of the key contributors to foot problems in patients with diabetes; affecting the autonomic nerve fibres along with the motor and sensory nerve fibres in patients with type 1 and type 2 diabetes.

Patients with diabetes and neuropathy are at a higher risk of ulceration as compared to patients without this complication.

Sensory neuropathy affects the patient’s ability to feel any pain or discomfort in the foot area. This leads to an unawareness of trauma, delayed presentation of a patient with developing ulceration and/or infection, and an increased risk of amputation.

The patient is unable to feel abnormal pressure points during gait as the biomechanics of the foot often increases plantar pressures in the diabetic foot. This causes an increase in the motion of the affected joints and consequently, an increase in shear forces.

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The dysfunction caused in the motor nerve fibres due to peripheral neuropathy, results in the formation of calluses, which may cause ulceration underneath. The regular removal of calluses, in this regard, becomes a key measure in the prevention of foot ulceration.

If the patient hyperpronates while walking, the pressure under the first metatarsal head and medial aspect of the heel increases. This can also increase the chances of ulceration.

A thorough assessment of the patient’s feet is critical along with screening initial diabetic patients for the risk of ulceration, by evaluating their circulation (pedal pulses and subpapillary venous plexus filling time) and their protective threshold with a 5.07 Semmes Weinstein monofilament test.

Any kind of prominent bony growth or old ulceration sites should also be checked.

After having classified the patient into a foot risk category, an appropriate orthotic should be chosen in order to prevent any infection or the risk of amputation.

If surgical intervention is required, it becomes necessary to perform the surgery first and to introduce orthotics or special shoes later to salvage the foot or limb.

Custom orthotics help to improve ambulation by reducing the hyperpronation and the stress on the muscles of the foot and leg. This allows the patient to remain active with walking and exercises, lessening the possibility of other diabetic complications such as heart diseases, kidney disease or a stroke.

In a study conducted by Albert and Rinoie, custom made orthotics were observed to reduce plantar pressure under the first metatarsal head and medial heel by 30 to 40 percent.

While maximising the remaining functional integrity of the foot, MASS4D® custom orthotics also offer a special Bi-Lam cushion top cover for use with patients suffering from insensate foot symptoms.

This provides protection against unnoticed blistering or ulcerations for this population, in addition to helping improve functionality in the lower limbs.

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References:

1. Anna Korzon-Burakowska, Piotr Dziemidok (2011) Diabetic foot – the need for comprehensive multidisciplinary approach. Annals of Agricultural and Environmental Medicine: November 2011, Vol. 18, No. 2, pp. 314-317.
2. Eric M. Feit, Alona Kashanian (2002) Key Prescription Pearls For Diabetic Orthotics. Podiatry Today: March 2002, Vol. 15, No. 3. Retrieved from http://www.podiatrytoday.com
3. Albert S., Rinoie C. (1994) Effect of custom orthotics on plantar pressure distribution in the pronated diabetic foot. Journal of Foot Ankle Surgery: November/December 1994, Vol. 33, No. 6, pp. 598-604. 

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