Friction Management. For Diabetic Foot Problems
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1 Friction Management For Diabetic Foot Problems Presented at the 36 th Annual Meeting and Scientific Symposium of the American Academy of Orthotists and Prosthetists Technical Workshop #33: Diabetic Foot Problems and Novel Ways to Treat Them with ShearBan Prepared by Mark Payette, CO February, 2010
2 Diabetic / Neuropathic Foot Problems 23.6 Million Americans (7.8% of Population) 1958 = 1.5 Million 2007 = 17.9 Million 5.7 Million do not know they have Diabetes Health Care Costs = $174 Billion (Direct Medical Costs = $116 Billion) 20% of people who present for routine care will have a treatable foot care problem 15% lifetime incidence of foot ulcer Ref: National Diabetes Education Program Statistics and NIH Publication Working Together to Manage Diabetes 2007
3 Preventive Foot Care in Diabetes Risk Identification Patient Education Provider Education Foot Exam Prevention of High Risk Conditions Management of High Risk Conditions Ref: American Diabetes Association - Diabetes Care, Volume 27 Supplement I, January 2004
4 Patient Education Implications of Sensory Loss Assessment of Knowledge and Care Practices Importance of Daily Foot Monitoring Selection of Appropriate Footwear Nail and Skin Care Ability to Self Assess Foot Condition Care Assistance Ref: American Diabetes Association - Diabetes Care, Volume 27 Supplement I, January 2004
5 Goal for Low-Risk Foot Patient education Keep Low Risk Status Control ABC s: A1C, Blood Pressure, and Cholesterol Lipid Profile Tobacco Cessation Ref: NIH Publication Working Together to Manage Diabetes 2007
6 High Risk Foot Status Loss of Protective Sensation Foot Deformity Absent Pedal Pulses Prior Amputation History of Foot Ulcers Ref: NIH Publication Working Together to Manage Diabetes 2007
7 Goal for High Risk Foot Patient Education Prevent Foot Ulcers Self-Management Education Stress The Role of Minor Trauma Clear Walking Spaces of Potential Hazards Prompt (Same Day) Care for Injuries Regular Foot Care (Podiatry, Pedorthic/O&P) Use Appropriate Footwear Ref: NIH Publication Working Together to Manage Diabetes 2007
8 Foot Evaluation Neuropathy Vasculopathy Dermatological Conditions Musculoskeletal Symptoms Lifestyle and Family History Ref: NIH Publication Working Together to Manage Diabetes 2007
9 Pedorthic / O&P Interventions Proper / Ideal Footwear Accommodate Deformities Cushion and Redistribute Pressure Patient Education Follow Up Ref: NIH Publication Working Together to Manage Diabetes 2007
10 What Else Can We Do?
11 Pressure Force Off-loading is Routine
12 Pressure Force Off-loading is Routine Shear/Friction Force Off-loading Should also be Routine!
13 Dr. P. F. D. Naylor British Journal of Dermatology (1955) There is an inverse relationship between the friction force and the number of rubs required to form a blister
14 Spence and Shields Journal of the American Podiatry Association (1968) Blisters, Callosities and Ulcers are primarily caused by excessive shear forces, commonly referred to as friction acting on the skin
15 Repetitive Loading Most trauma on the foot is generated by repetitive loading associated with ambulation The load is applied, reaches a maximum, then is released / reduced This cycle repeats again and again with each step The skin takes the first injury and sends the first warning (if sensation is intact)
16 Joseph Knapik Journal of Sports Medicine (1995) Excellent Review of Repetitive Loading Skin Trauma Research Findings with very useful explanations for Military and Sports Application
17 What About Pressure? Tissue Trauma from Pure Pressure Looks like a Bruise
18 Friction Loading Against the Skin Reddened Skin Areas Angry, Red Skin Skin Rubbed Off Blisters Calluses Ulcers
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20 How are Pressure Loads and Friction Loads Related? Friction Forces Do the Damage BUT There Can Be No Friction Without Forceful Contact (Pressure)
21 XXX
22 XXX
23 XXX
24 Please Notice Friction Load Peaks Can Be No Greater Than Contact Pressure Load (L n ) Times CoF
25 Coefficient of Friction (CoF) Ratio of the force required to slide two materials (in contact) to the force perpendicular to the surfaces A lower friction coefficient indicates that there is less resistance to the sliding motion The CoF is always related to two materials
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28 Friction is Not All Bad Stability Control Suspension Propulsion Energy
29 Friction is Only Bad Where it Peaks High Enough To Cause A Problem Reducing CoF In Identified Problem or Risk Areas is Friction Management
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31 Shear / Friction Forces Generated By Relative Movement of Bones Within the Shod Foot
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36 Tamarack Habilitation Technologies Introduces ShearBan Technology
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38 Skin Mobility ; A Critical Issue Scarred / Adhered Areas Skin Grafts
39 Adhered scars and skin grafts will see the limiting friction load whatever it is So we must make the friction load low
40 Pressure Force Off-loading Shear/Friction Force Off-loading
41 Questions / Discussion
42 Since 1998 Ongoing testing and improvements Product guide
43
44 Clinical Case Examples Courtesy of: Dennis Janisse, CPed Charlie Kuffel, CPO, FAAOP Dane Hupp, PT
45 Courtesy of Dennis Janisse, CPed National Pedorthic Services, Inc.
46 50 y/o Male Diabetes, Type 2 Diabetes Peripheral Neuropathy, Previous Amputations Courtesy of Dennis Janisse, CPed National Pedorthic Services, Inc.
47 3 months later Courtesy of Dennis Janisse, CPed National Pedorthic Services, Inc.
48 Courtesy of Dennis Janisse, CPed National Pedorthic Services, Inc.
49 Courtesy of Dennis Janisse, CPed National Pedorthic Services, Inc.
50 68 y/o Male Type 1 Diabetes, Charcot Deformity Neuropathy, Post ulcerations Courtesy of Dennis Janisse, CPed National Pedorthic Services, Inc.
51 70 y/o Female Arthritis Midfoot/Toe Deformities Courtesy of Dennis Janisse, CPed National Pedorthic Services, Inc.
52 Courtesy of Dennis Janisse, CPed National Pedorthic Services, Inc.
53 Courtesy of Dennis Janisse, CPed National Pedorthic Services, Inc.
54 Case Study 1 Courtesy of Charlie Kuffel CPO, FAAOP Arise Orthotics and Prosthetics
55 Case Study 2 Before After (11 weeks) Courtesy of Charlie Kuffel CPO, FAAOP Arise Orthotics and Prosthetics
56 Case Study 2 Courtesy of Charlie Kuffel CPO, FAAOP Arise Orthotics and Prosthetics
57 Callus Care Courtesy of Dane Hupp, PT National Hansen s Disease Center
58 Courtesy of Dane Hupp, PT National Hansen s Disease Center
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