Orthoses for Patients with Diabetes
Preventing foot ulceration is critical in the overall treatment of diabetic patients. Ulcer prevention includes patient education, regular screening, use of proper shoes and socks, palliative care as needed and the use of orthotic devices specifically designed to reduce those forces that are likely to lead to ulceration.
It's All About the Forces
The goal in prescribing orthoses for the at-risk diabetic patient is to provide an orthosis that decreases the forces that are likely to lead to foot ulceration. Traditionally, the primary goal for this population has been to decrease pressure, or those forces that act horizontally on the plantar foot during ambulation. Although numerous studies have reported a relationship between increased pressure and ulceration (1 - 3), ulcer prevention is much more complicated. There is significant evidence that shear – or friction – forces play just as critical a role, and possibly more critical, in ulcer etiology and thus must be addressed when prescribing foot orthoses for the at-risk diabetic patient.
The following pages provide detailed information on how to best write orthotic prescriptions to prevent and treat foot problems that are common in the diabetic patient.