Key Prescription Pearls For Diabetic Orthotics

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Table 1: How To Assess The Foot Risk Categories (FRC)

FRC Protective Threshold Vascular Disease History of Ulcer Orthotic Type
0 WNL WNL WNL Prefabricated
1 Absent WNL WNL Prefabricated
2 Absent Abnormal WNL Custom
3 Absent Abnormal Positive Custom

For the rigid diabetic foot type, you should use softer materials when prescribing orthotics.
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Author(s): 
By Eric M. Feit, DPM, FACFAS and Alona Kashanian, DPM

If you see a need for further control of forefoot lesions, consider adding an extrinsic metatarsal bar to the ready-made shoe. This addition will allow you to provide easier propulsion and off weightbearing of the forefoot. You can also prescribe a rocker-bottom shoe for the diabetic patient, who appears to have an apropulsive gait. Any good shoemaker in the community is able to incorporate either a metatarsal bar and/or a rocker-bottom addition.
Most prosthetists will dispense pre-fab plastazote type orthotics for extra depth or custom made shoes. These are often in layers of pink and white plastazote with occasional poron or ppt. These devices do not control the foot well and typically wear out in one to two months, depending upon the activity level of the patient.
Final Notes
Emphasize to your patients that the biomechanics of their feet affect their risk for ulceration, and that a custom-made device will provide better protection. Indeed, it is our role to protect the diabetic foot from ulceration, and to explain to our patients that what they can’t feel can hurt them. n
Dr. Feit is a Diplomate of the American Board of Podiatric Surgery and is the Director of Research at the San Pedro Peninsula Hospital Residency Program. He is also in private practice in San Pedro and Torrance, Calif.
Dr. Kashanian is a Diplomate of the American Board of Primary Medicine and Podiatric Orthopaedics, and is a consultant for ProLab Educational Institute. She is also in private practice in Northridge, Calif.
Dr. Steinberg is an Assistant Professor in the Department of Orthopaedics/ Podiatry Service at the University of Texas Health Science Center.




References:

References

1. Boulton, A.J.M., Hardistry, C.A., Betts, R.P., et al. Dynamic Foot Pressure and other studies as Diagnostic and Management aids in Diabetic Neuropathy. Diabetes Care 6:26-33, 1983.

2. Albert, S., Rinouie, C.Effect of Custom Orthotics on Pressure Distribution in the Pronated Diabetic Foot. J. Foot Ankle Surg., 33: 598-604, 1994.

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