Proactive measures for the at risk foot

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1 Footwear and orthoses designed with soft and molded surfaces can lower plantar pressure by increasing the foot-contact area, where pressure equals force over area. Birke, Foto & Pfiefe (1999) Proactive measures for the at risk foot Foot ulceration through diabetes is the leading cause of lower limb amputation in the US and is today accepted as a growing problem in the UK. According to Diabetes UK, 1.4 million people in the UK suffer from the disease. From this figure around 5% of sufferers will develop foot ulcers that could lead to 'avoidable' amputation. The good news is that simple preventative measures can greatly reduce the risk of foot ulcers in diabetic patients. As you may know, neuropathic feet, especially those with deformity, should always be protected with some form of accommodative pressure and shear-dissipating insert. The harder the surface and the less accommodating the insert, the greater the risk of plantar ulceration. Modern materials supplied by Algeos provide the professional with new improved methods of treatment and protection for the diabetic foot. Over the past five years Algeos have undertaken a programme of material and component evaluation to find the most effective materials and products for use with the diabetic foot. Using up to the minute research and advice from leading diabetes and footcare experts, as well as utilising our own in-house knowledge of materials technology, we feel we have finally established the definitive diabetic foot care range. Left: Illustration of plantar pressures using the Tekscan pressure measurement system A. Algeo Ltd Sheridan House Bridge Industrial Estate Speke Hall Road Liverpool, L24 9HB. t: +44 (0) e: sales@algeos.com

2 Diagnostics & prescription Retractable Monofilaments Monofilaments are designed to test the loss of sensation in the feet of diabetic patients. If a patient cannot feel a 10g monofilament then they must be considered to be at risk of developing a neuropathic ulcer. General features: Measures both diminishing and returning sensation, ideal for screening peripheral nerve impairment and detecting changes in neurological status. Monofilaments resist damage, thus saving time and expense of replacing and recalibrating Monofilaments are portable, practical, compact and easy to use. Ideal for the busy clinician. Monofilaments are unaffected by atmospheric moisture, allowing total reliability at all times. FootDoc Foot Impression Sheets FootDoc foot impression sheets can dynamically identify foot type in less than 60 seconds. All your customer needs to do is step on and off this unique 'pressure sensitive paper'. This simple walking motion provides you with a permanent foot imprint for sizing and fitting your customer to just the right shoe - without messy inks or expensive computer software. FootDoc offers these important advantages: Instant biomechanical analysis Helps to ensure a better fitting shoe or foot orthotic Offers the potential to identify serious foot problems No messy inks or expensive computer software Flat The detailed print made on FootDoc is made visible on the pattern printed bottom sheet, so you can measure the areas of various pressure regions. A proper fitting shoe is essential for those customers with diabetes, particularly those with a high arch. High Arch If desired, outline these pressure areas with a water soluble ink marker. Neutral 2

3 Diagnostics & prescription Rothballer Scan System The Rothballer Scan System is a computerised foot scanning system that provides the busy clinician with the ability to diagnose and efficiently prepare treatment plans for patients. Extremely versatile, the Rothballer System can be used for many foot care related treatment programmes including shoe prescription and foot orthotic selection. data entry patient scan assessment treatment plan Improved workflow Workflow is efficently combined and structured with the Rothballer Scan System appliance selection job sheet production Patient database: Full and detailed organisation of patient data Software is interfaced to scanning program directly (no entering of data twice) Ability to transfer data to a lab, supplier, patient or store by , fax, post or through a computer network Helps workflow planning and implementation Scan presentation: A high resolution scan allows a better localisation of problem zones 1:1 presentation of feet allows precise printouts to be produced Marking and writing functions allow notes and manufacturing advice to be applied directly to the scan Visual on-screen help to explain foot problems 3D presentation for the foot Detailed data sheets: Special predefined data sheets to assess neuropathy, general biomechanics and proprioception Using the optional Rothabller Cam, assessment of patients walking or running patterns can be recorded and assessed over time in line with treatment 3

4 Orthotics for pressure relief Silicone Orthotics Anti-shock silicone protection Available in full length, 3/4 and heel cup sizes Provides shock absorption to the heel, longitudinal arch and the metatarsal areas Proven to reduce stress to the ankle, knee, hip-joint and adjoined lumbosacral area This product is available both with and without a met dome. Please quote when ordering Sizes: (5-12 UK) Diabetes Functional Functional Orthotic for reducing forefoot loading The Worlds most advanced diabetes foot orthotic Inverted rear foot improves biomechanical function and enhances the windlass effect 6 Moderate arch height provides adequate functionality for the majority of patients Open cell urethanes such as PORON have been proven to reduce vertical pressures by up to 18% Reduces forefoot loading by controlling the rate and duration of pronation Sizes: (1-12 UK) About the materials PORON 96 sets a new level of advanced underfoot comforttechnology. The slow rebound quality of the material cradles the foot and allows enhanced redistribution of body weight over the foot's plantar surface. All materials from the PORON family pass both the Schwartz and Peck Human Patch Tests (for primary skin irritation) and USP Class VI toxicology testing. Orthotics manufactured from Polyurethane absorb 10.4 joules of energy when new compared to standard EVA which absorbs 5.9 joules. About the design DF Orthotics are based on the biomechanical design principles of one of the World s leading foot orthotic developers: Interpod. The design of this orthotic is fully supported by clinical research which can be provided on request. 4

5 Orthotics for pressure relief Duosoft PLUS Advanced Orthotic with PORON 94 top cover For individuals with diabetes, arthritis, or other conditions that result in sensitive feet PORON 94 self-contouring top cover which allows redistribution of body weight over the foot's plantar surface Vygel heel provides optimal shock attenuation Moulded cellular urethane for superior shock absorption, high resilience and cushioning Sizes: (5-12 UK) PORON 94 is a softer, lighter PORON with slower rebound. This allows for more even distribution of body weight over the foot's plantar surface and offers fuller, richer cushioning. Duosoft Therapeutic Anatomically structured Orthotic Designed to provide cushioning, accommodation and absorbency required for the Diabetic/insensate foot Anatomical design is designed to facilitate off-loading of the metatarsal head area Plastazote and Urethane combination Distinctive self contouring capabilities and hypoallergenic formulation customises to the foot to accommodate pressure hot spots Sizes: (1-12 UK) Trilam Triple durometer Orthotic Plastazote top cover, PORON cushioning and a high quality EVA base Excellent shape retention and support Long-lasting Orthotic ideal for diabetics and arthritics A top layer of Plastazote conforms for a custom fit to the individual Sizes: (3-12 UK) 5

6 Bespoke appliance components PORON Urethanes - Advanced underfoot cushioning PORON is a microporous polyurethane foam which is able to cushion effectively the 'stepshock' of walking and running. Its open cell structure gives the material the ability to absorb a measure of the moisture vapour generated by the active foot. The Highest Degree of Shock Absorption More shock absorption in the insole means less shock to feet and joints. No other insole material offers more shock absorption than PORON cellular urethanes. In side-by-side drop weight tests, PORON materials outperformed vinyl sponge, neoprene sponge, sponge rubber, latex foam and solid viscoelastic. This is why PORON materials offer the best cushion against impact. We stock this product in 6 different resiliencies for diabetic appliances: Dual Layer - Multi-functional Durable - Merged cell structure Cushioning - Prevents excess stress to foot Support - Conforms to the individual foot Comfort - Exceptionally smooth to the touch Blue - Medical grade soft cushioning USP Class VI Certification Fungal Resistant Breathable - Keeps foot cool, dry and odourless Salmon Pink - Slow memory A softer, lighter PORON Slow memory allows for maximum cushioning Red - Ultrasoft slow memory Unique custom contouring - Controlled energy return Supports stability and balance Excellent impact absorption PORON Dual Layer Standard Insole Maximum Retention of Comfort and Flexibility PORON materials are made without plasticisers, which means the insole won't shrink or become brittle and crack with age. Jade - Medical grade slow memory USP Class VI Certification Extremely slow memory allows for maximum cushioning PORON Gel - Dual layer cushioning Combines polymer gel to PORON 4000 Advanced shock absorption and cushioning support PORON insoles retain like-new softness and flexibility - even at temperatures of up to -40 F, resisting the tendency of other insole materials to bottom out and take a permanent compression set. A Breathable Layer to Help Feet Stay Dry and Cool Insoles made with PORON material form permeable layers that draw water vapour and perspiration away from the foot, helping to keep shoes and feet dry, while reducing foot odour. Superior performance in just about every conceivable category, and resistance to abrasion, friction, tension, and stitch stress. PORON materials are lightweight, smooth to the touch, and resist piping, for the greatest degree of shoe comfort, over the greatest length of time. PORON Bespoke services: Self-adhesive backing Other sheet colours may be available for orders of over 300 sheets. Die cutting, laminating and splitting service For any of the above services please contact us 6

7 Bespoke appliance components Diabetic appliance manufacture with nora Luna EVA The nora Luna range is a system of high specification, multi density EVAs used commonly for foot orthotic and appliance moulding. nora EVA offers excellent wearing powers and moulding properties, with each manufacturing batch being of a consistently high standard. All nora Luna products bear the "pollutant test" SG seal. The latter is exclusively affixed to products fulfiling the exacting demands imposed by the limit values and pollutant parameters stated in the list of SG test criteria, e.g. parameters relating to aromatic amide from colouring agents. This SG seal confirms that no risks should be feared for health, both for adults and children, according to the latest technological findings, thus providing the greatest safety for processors and patients alike. The compatibility of nora Luna products with the skin has been tested and confirmed by the Fresenius Institute for all colour variations and hardnesses. These nora products are subject to constant supervision and bear therefore the "tested skin compatibility" quality seal. Advantages using nora Luna EVA: Hypoallergenic and skin compatibility Easy to clean Easy moulding Combinable One complete system No bottoming out Security of quality No special covering materials are needed because nora EVA is a closed cell material (Fresenius and SG certificate are available). Ideal for the diabetic foot. Washable with hot water or in a washing machine at up to 50 C. All densities are thermomouldable. By combining two or more densities, you will obtain the desired combination necessary for the specific problem of each patient, like: foot adaptation, cushioning and pressure distribution. Using nora EVA eliminates the need for other materials. You ll get perfect results and there will be no working or cementing problems. nora s high flexibility makes it long lasting and gives a high level of stability (Satra certificate available). Stable parameters of the material (ISO 9002 certificate available). tested quality compatible with the skin 7

8 Bespoke appliance components A huge choice of shock absorping materials Algeos cushioning materials are used in orthotics to minimise the magnitude of compression and shear to the foot when it comes into contact with the ground during locomotion. These materials have been incorporated as an interface between the plantar surface of the foot and the shoe sole. They provide benefits, that are very important to a Diabetes sufferer including shock attenuation, friction reduction, and weight dispersion which protects the denervated foot from harmful forces. Astrosorb This high specification solid elastomer material absorbs 99% of impact energy. With a hardness of shore A25, specific gravity of 1,08g/cm3, and a design for anti-vibration and engineering uses, Astrosorb is one of our heaviest duty products. Maxacane Silicone Gel A uni-directional material which accommodates calcaneous spurs and other bone problems of the feet. Contains a mineral oil that will continually lubricate very dry skin. Available with Nylon cover. GP Diabet A special bedding material that can be used by Diabetics or other people in need of highly sensitive care of the foot. Diabet material has the ability to return to 100% of its initial form and therefore ensures individual foot bedding. It is available in two thicknesses (5mm and 10mm) and three densities dependent on the weight of the user. Orthosorb Orthosorb offers less absorption action that leads to better cushioning and higher elasticity, making it especially suitable for orthopaedic footwear. Algefoam A low density EVA. This closed cell material has excellent thermo - forming properties. It is lightweight, self accommodating and is available in a wide range of densities and colours. Plastazote A polyethylene foam which is a thermoplastic. These foams are closed cell, non toxic, fluid resistant, lightweight and heat mouldable. Plastazote is readily washable therefore discouraging bacteria growth, and is available in various densities. Sponge Rubbers Commonly known as EPDM (Ethylene Propylene Diene Monomer). A closed cell rubber usually of soft/low density. Available in black and white sheet forms. Popular for add - on pads for valgus and metatarsal support, and also as a lining material. EVA A very versatile material that is supplied in sheet form. We stock 8 different densities and many colours and thicknesses from 0.75mm up to 24mm. EVA (Ethyl Vinyl Acetate) is easily moulded, has cushion absorbing properties and good tensile strength. Neoprene Rubber A synthetic polychlorprene that has excellent wear properties, and offers cushioning and shock absorption. A closed cell material that was designed to absorb lateral and oblique forces and to prevent blisters. The gliding motion of the individual cell chambers accounts for neoprene s ability to move both laterally and vertically. Nitrogen gas is used to cure foam neoprene, which limits the cells to a certain size and thereby avoids rupturing. A top cover of nylon is often used to stop the foot sliding over the surface. 8