Preventing Foot Ulcers in the Neuropathic Diabetic Foot. Glossary of Terms

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Preventing Foot Ulcers in the Neuropathic Diabetic Foot Warren Woods, Certified Orthotist, Health Sciences Centre, Rehabilitation Engineering Department What you need to know Glossary of Terms

1 Preventing Foot Ulcers in the Neuropathic Diabetic Foot Warren Woods, Certified Orthotist, Health Sciences Centre, Rehabilitation Engineering Department What you need to know Glossary of Terms Neuropathic Nerve Damaged Insensitive Lacking Protective pain sensation and feeling Bony Prominence Area of the feet where the bone is close to the surface for the skin without any protective fat padding (this is where ulcers occur) 1

2 Glossary of Terms Foot Orthotic (shoe insert) Device placed in shoe to relieve bony prominences ( Protect bony prominences from excess pressure Hyperkeratosis Excessive callus formation caused by excess pressure Extra depth shoe A shoe with extra depth in the toe box to accommodate foot deformities Treatment Goal Prevent ulcer and callus formation Pressure to a safe level at the plantar, dorsal and lateral aspects of the foot Lower the rate of callus formation (or reverse process) Pressure so an ulcer can heal and remain healed Prevent the occurrence and recurrence of pressure ulcers 2

3 Bony Prominences Claw Toe Deformity 3

4 Calluses Caused by excessive Pressure Protective mechanism over a bony prominence If too thick can lead to tissue damage and ulcer formation Most common areas of occurrence: Planter metatarsal heads Dorsum of toes, medial side of first M.T.H. Pathogenesis of Ulcer DM Peripheral Neuropathy Protective Sensation, Muscle Atrophy & Imbalance Clawing of Toes, Pressures at the Met Heads Pt. Continues to Ambulate without Protective Pain Sensation Callus formation under prominent Met Heads Pressure & shear of tissues between bone & callus Occlusion of & damage to capillaries Tissue compromise & Ulcer Formation Healing cast, Amputation Non ambulatory Pt. Prosthesis Orthotic Intervention to Pressures callus formation and maintain pressures at a safe level. (proper Footwear) Healing cast, Orthoses,, Hospital stay? 4

5 Bed Sores and Neuropathic Diabetic Foot Preventable Caused by excessive pressure and shear Occur over a bony prominence Occur in a neurologically compromised patient Are treated with wound care and pressure relief methods Decubitus Ulcers Ulcers Where do Pressure Ulcers Occur? Between hard callus and bone Over a bony prominence At areas of excess pressure At areas where there is no protective padding 5

6 Excessive pressure is the problem Pressure reduction or elimination is the solution. How do we achieve this? Total Contact foot Orthotic Orthotics How they work We cannot eliminate pressure on the bottom of the foot but we can reduce pressure to a safe level 6

7 Total Contact foot Orthotic Total Contact Foot Orthotic A1 B1 B1 B2 Fig A1. The soft non-molded insole (a) which does not distribute the weight-bearing pressures evenly and completely to the plantar surface (A2). Fig B1. A molded insole (a) fitting against the planter surface to distribute the weight-bearing pressures evenly to the plantar surface (B2). 7

8 CHARCOT FOOT Shoes for the Neuropathic Foot Must be wide and high enough to accommodate (not correct) the existing deformity Tight shoes cause foot ulcers on the side and top of the foot 8

9 Shoes for the Neuropathic Foot The fabric of the shoe upper cannot be tight Stretching or modification may be necessary Shoe Features Cambrian #6414 9

10 Rocker Sole Conclusion Pressure ulcers and calluses are caused by excessive pressure Our goal is to lower pressure to a safe level The total contact foot orthotic and rocker sole lower pressure on the plantar surface of the foot 10

11 Conclusion Extra depth footwear functions to: Support the foot Accommodate deformities Lower the pressure on the side and top of the foot to a safe level Without pressure relief amputation may be the end result. Questions? THE END 11

12 Handout Why do I wear foot orthotics? To prevent calluses and ulcers from forming on the bottom of your r feet by spreading pressure evenly The blood vessels in your feet are squished between the hard calluses c and your foot bones. When the blood vessels are squished, nutrients and oxygen cannot get to the tissues in the feet and the tissue then die and an ulcer is formed Then what happens? An infection can occur at the ulcer sight. This can be very serious and can lead to amputation of the foot and the lower leg below the knee When do I wear my foot orthotics? Whenever you are on your feet, both inside and outside your home for the rest of your life What else can I do to prevent ulcers? Keep the calluses on your feet from getting too large and thick by soaking your feet daily and gently rubbing calluses with an emery board or pumice stone Having your calluses reduced by a Registered Nurse (RN) who has experience in dealing with diabetic feet, if necessary Inspect your feet and toes daily and see your Doctor or Nurse if you notice any redness that does not go away, skin breakdown, foul odors, blisters,etc. 12

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