diabetic footwear considerations

1. DIABETES MELLITUS
CORRECT FOOTWEAR
FOR GRADE 1 FOOT
PRESENTED BY KSRS.PRASAD

2. OUR INSPIRATION
• OBSERVATIONS IN VARIOUS MEDICAL TEXT BOOKS,
JOURNALS AND FINALLY IN THE INTERNATIONAL
CONSENSUS ON THE DIABETIC FOOT
• ST.VINCENT DECLARATION WHICH AIMS AT REDUCING
AMPUTATIONS OF THE LOWER LIMB IN DIABETICS BY 50%
& OUR OWN APPROPRIATE BACKGROUND AND COMMITMENT
TO THE CAUSE AND TO THE MEDICAL FRATERNITY
TOROUGHLY SUPPORTED BY OUR VAST AND CONTINUING
RESEARCH EXPERIENCE AND EXPERTISE.

3. THERAPEUTIC/PROTECTIVE
FOOTWEAR
• Therapeutic footwear is used to remove the mechanical
load off the foot
• Total contact cast/orthoses may be used
• Protective footwear should include footwear for both
indoor and outdoor use
• Protective footwear is based mainly on
accommodation,cushioning and stabilisation
• Patients should know that wearing appropriate footwear
is a life-long commitment and even short periods of
wearing inappropriate footwear may result in an ulcer
• Ill-fitting shoes cause ulcers to the digits or the dorsum

4. HOW TO PREVENT FOOT
PROBLEMS?
• REGULAR EXAMINATION OF THE “AT RISK” FOOT
• IDENTIFYING OF PATIENTS WITH “AT RISK” FEET
• SIMPLE AND REPETITIVE EDUCATION TARGETED
AT HEALTHCARE PROVIDERS AND PATIENTS
• ADEQUATE PREVENTIVE FOOT-CARE
IRRESPECTIVE OF SOCIO-ECONOMIC STATUS
• PERCOLATION OF KNOWLEDGE THAT THERE IS
NO SUCH THING AS A TRIVIAL LESION OF THE
DIABETIC FOOT
• MULTIDISCIPLINARY FOOT-CARE TEAMS

5. CORRECT DIABETIC FOOTWEAR
CONSIDERATIONS
• THE SOLE
• THE INSOLE
• THE UPPER
• THE DESIGNS
• MAKING PRINCIPLES
• FITTING PROCEDURE
• FOOTWEAR CARE/ FOOTWEAR ORTHOTIC
MODIFICATIONS

6. THE SOLE
• RIGID SOLE/ROCKER BOTTOM SOLE IN FORE
FOOT ULCERS
• BROAD/LIGHT/TOUGH SOLE
• LOW HEEL/FLAT BOTTOM SOLE WITHOUT A
SEPARATE HEEL
• SOLE WITH GOOD ANTI-SKID GRIP/ ROUNDED AT
HEEL FOR EASY HEEL STRIKE/ RESPECTABLE
WALKING ANGLE FOR TOE-OFF WITHOUT
PRESSURE ON METATARSALS

7. THE SOLE CONT..
• HEEL PITCH TO ACCOMMODATE PHYSIOLOGICAL
FLEXION OF THE KNEE (PREVENTS
HYPEREXTENTION OF KNEE AND PAIN OF
HAMSTRINGS THEREOF). THE HEEL SHOULD ALSO
SUPPORT THE ARCH
• THE SOLE IS NOT SOFT AND DOES NOT SINK
UNDER THE BODY WEIGHT( A SOFT SOLE CAN
CAUSE DORSIFLEXION OF THE FOOT CAUSING
STRAIN ON HAMSTRINGS AND ENERGH LOSS)

8. THE SOLE CONT…
• NOT FLEXIBLE AND SO DOES NOT CAUSE TOE-
BREAK OR HIGH PRESSURE ON THE
METATARSALS
• THE SOLE SHOULD NOT BE THICK CAUSING
EXCESSIVE GROUND CLEARENCE MAKING THE
ANKLE VULNERABLE TO FRACTURES
• WE ARE WORKING ON A SPECIAL CONVERTABLE
COMBINATION SOLE THAT SHOULD SERVE ALL
THE NEEDS OF DIABETIC FOOT

9. OUR CRITICALLY IMPORTANT
SPECIAL POLYMER INSOLE
• EXCELLENT COMPRESSIVE STRENGTH-Significantly
higher than even PU foam/has a smooth surface and a
soft feel
• EXCELLENT RESILENCE-Has excellent recovery after
repeated flexing/compression
• VERY GOOD TENSILE AND TEAR STRENGTH-
Remarkably tough/capable of taking repeated harsh
treatment with little effect
• OUTSTANDING MOISTURE RESISTANCE- Closed
cell structure/hydrophobic/water absorption and water
vapour transmission rates are negligible

10. SPECIAL MCP INSOLE CONT..
• CHEMICAL RESISTANCE- Has excellent chemical stability
when exposed even to acids,paints,varnishes,thinners and
alcohols
• THERMAL INSULATION-Excellent thermal insulator and is
35% better than any other soft foams
• SERVICE TEMPERATURE- Can be used in temperatures up
to 70 degrees centigrade without significant effect on its
properties
• BUOYANCY-Its low density,closed cell structure and water
proof properties allow MCP to remain buoyant even when
sliced or punctured

11. SPECIAL MCP INSOLE CONT…
• 15+2 Degree Shore A Insole as per Medically Accepted
Standards. This softness minimises shock to the plantar
surface and prevents sub-cutaneous hemorrhage.
• 8mm Thick to suit even heavy persons
• Establishes total contact with the foot on regular use
thereby reduces Neutons( pressure) per unit area of the
foot (ANASTOMOSIS).
• No Designs or Patterns on the Insole as these are found
to affect the Plantar Pulp.

12. SPECIAL MCP INSOLE CONT…
• No Arch supports given as it is never possible to provide
an accurate arch support to all( it is never uniform). A
higher than necessary arch support causes inversion of
the foot and leads to undue pressure on the lateral arch
• The insole establishes Total Contact and forms natural
and correct arch supports
• The insole is not pasted in the shoes and can be
conveniently replaced whenever called for
• We are working on many superior polymers, Total
Contact insole techniques and materials

13. THE UPPER MATERIALS
• IDEALLY SOFT LEATHER
• SOFT POROMERIC MATERIALS
• THE LINING HAS TO BE LEATHER OR POROMERIC
• CLIMATIC CONDITIONS TO BE GIVEN ULTIMATE
IMPORTANCE IN FINALISING UPPER/ LINING
MATERIALS
• NON-WOVEN FABRIC LINED UPPERS IN SANDALS
UNDER STUDY TO DEVELOP ECONOMIC
FOOTWEAR

14. DESIGN-SANDALS
• ONLY BROAD STRAPS(NO NARROW
STRAPS/NO WEBBING)
• NO TOE-RING/NO TOE-STEM
• FULL OR ADEQUATE HEEL COUNTER
• ADJUSTABLE UPPERS TO ACCOMMODATE
OEDEMA
• NO THICK THREAD STICHING ESPECIALLY
IN THE QUARTER

15. DESIGN-SANDALS CONT…
• CUT, PASTE AND LAST METHOD MOST IDEAL
• PROPORTIONATE AND ACCURATE WINDOWS AT
THE 1ST
AND 5TH
METATARSALS MANDATORY
• NON-ADJUSTABLE UPPERS FOR THOSE NOT
HAVING THE PROBLEM OF OEDEMA IS
ACCEPTABLE
• MAXIMUM COVER OF THE FOOT MEANS MAXIMUM
PROTECTION

16. DESIGN-SANDALS CONT…
• NO HARDWARE/ BUCKLES WITH THONGS
• ONLY VELCRO STRAPS AND SOFTER FORM OF
VELCRO TO FACE THE SKIN
• EASY TO WEAR DESIGNS KEEPING THE AGE
GROUP AND ACCOMPANYING MUSCULO-
SKELETAL PROBLEMS IN VIEW
• DESIGNS FINALISED AFTER THOROUGH TRIALS
ON GOOD NUMBER OF SUBJECTS ON A TWO- TIER
BASIS

17. DESIGN-SHOES
• BROAD TOE
• RAISED TOE
• WIDE FITTING ACROSS THE FOOT
• MINIMUM STIFFENER AT TOE BOX/HEEL
COUNTER
• ONLY DERBY MODELS WITH LACE/VELCRO
FASTNERS(NO SLIP-ON MODELS)
• INSOLE NEVER PASTED-REPLACABLE

18. DESIGN-SHOES CONT…
• NO THICK THREAD STICHING IN THE
QUARTER
• SOFT AND CONTINUOUS COLLAR
MANDATORY
• PUNCHED HOLES FOR LACE AND NO
ISLETS
• LACE WITHOUT METAL TIPS
• MODELS FINALISED AFTER PROPER TRIALS

19. MAKING PRINCIPLES
• EXTRA DEPTH SHOES
• UNIFORMLY THICK INSOLE AT BOTH HEEL
AND TOE TO PREVENT EQUINUS
• SKILLFUL LASTING PROVIDES WALKING
ANGLE
• NAILS/SHARP OBJECTS REMOVED INSIDE
SHOES AFTER LASTING

20. MAKING PRINCIPLES CONT…
• SOFT SIDE OF VELCRO TO FACE THE SKIN
• NO THICK THREAD STICHING INSIDE THE
SHOE
• NO METAL ISLETS/ METAL TIPS FOR LACE
• ENTIRE INSIDE OF THE SHOE TO BE FELT/
INSPECTED AND CLEARED AT THE TIME OF
QUALITY CHECK

21. FITTING PROCEDURE
• FIT SHOES LATER IN THE DAY
• TAKE THE FOOT SIZE WHILE STANDING
• MEASURE BOTH FEET(PROVIDE MIS MATCH
SERVICE OR FIT THE BIGGER FOOT SIZE AND
PROVIDE INSOLE TO ELIMINATE PLY IN THE
OTHER)
• FIT THE SHOE WITH THE BUYER WEARING
REGULAR SOCKS
• ENSURE GOOD GAP BETWEEN TIP OF TOE AND
TIP OF INSIDE OF SHOE

22. FITTING PROCEDURE CONT…
• CHECK THE FEET OF THE DIABETIC FOR
POSSIBLE CHANGES DUE TO PRESSURE
AFTER FIRST TWO HOURS OF USE
• ADVISE GRADUAL BREAKING INTO NEW
SHOES
• ADVISE GOOD FOOTCARE REGIMEN
• ADVISE PERIODIC MEDICAL SUPERVISION

23. FOOTCARE ADVISE/ PRODUCTS
• PERIODIC FOOT INSPECTION
• PERIODIC MEDICAL CHECK
• PROPER SOCKS
• PROPER PEDICURE
• FOOTWEAR INSPECTION EVERYDAY
• MOISTURISING CREAMS/DUSTING POWDERS
ETC., DEPENDING ON FOOT CONDITION
• REGULAR FOOT BATH IN WARM WATER WITH NON
DETERGENT BASED ANTI MICROBIAL LOTION
• NEVER TO WALK BARE FEET

24. FOOTWEAR MODIFICATIONS
• ORTHOTIC MODIFICTIONS BY TRAINED EXPERTS
• META-TARSAL BAR
• MEDIAL/LATERAL WEDGE
• SPLINTS
• HEIGHT ADJUSTMENT
• NEVER ADVISE A DITCH TO BE MADE IN THE
INSOLE AS IT CAUSES PRESSURE AT THE
PERIPHERY OF THE ULCER( THE ATTEMPT
SHOULD BE TO DISTRIBUTE PRESSURE/SHIFT
PRESSURE)

25. OUR COMMITMENT
• OUR BACKGROUND IS THE INSPIRATION BEHIND
OUR COMMITMENT
• CORRECT FOOTWEAR AT ITS BEST
• QUALITY AT EVERY STAGE OF MAKING-CHOICE
OF MATERIALS TO MAKING OF THE PRODUCT
• NO COMPROMISE PHILOSOPHY EVEN FOR
COMMERCIAL GAINS
• TOTAL FOOTCARE

26. THANK YOU
YOURS IN FOOTCARE
ALWAYS COMMITTED TO
DIABETIC FOOTCARE