Diabetes and Pedorthics: Conservative Foot Care
Diabetes can increase a person's risk of having foot problems. Since the extreme consequence is amputation, foot care for someone with diabetes becomes a daily priority.
That's where pedorthics comes in. Pedorthics (peh-DOR-thiks) is the management and treatment of conditions of the foot, ankle, and lower extremities requiring fitting, fabricating, and adjusting of pedorthic devices. It's an inherently conservative approach to foot health: using footwear to help alleviate foot problems.
As the footwear specialist on the health care team, a credentialed pedorthist works toward long-term maintenance of healthy feet and prevention of foot damage. Measuring a patient's feet, evaluating footwear, and making sure new footwear - including orthoses - fits properly allows the credentialed pedorthist to help prevent diabetic complications by educating the patient and communicating potential problems to the doctor.
Diabetes frequently results in neuropathy, or nerve damage, in the feet. Nerve damage can lead to loss of sensation, leaving a patient unable to feel pain, heat or cold. The longer a patient has diabetes, the greater the likelihood of developing the problem.
Shoes and foot orthoses protect the feet and improve their function. Since feet work in conjunction with legs, knees, hips, and back, footwear also affects a person's ability to perform physically. Foot problems can lead to stress and strain on other parts of the body. Millions of Americans use foot orthoses to ease such strain.
For people with diabetes, gradual loss of feeling in the feet interferes with the ability to judge whether shoes or orthotics fit and perform as they should. Friction or rubbing can go unnoticed and worsen into a break in the skin, or an ulcer. Shoes can be tied too tightly, hindering circulation. If a foot orthosis is needed, the patient may not be able to determine whether it is effective.
The Pedorthic Approach
Working from a doctor's prescription, a credentialed pedorthist alleviates foot problems by fabricating or modifying shoes and foot orthoses. The footwear adjustments may be internal, external or both. Once the shoes and/or orthoses meet the prescription's requirements, the credentialed pedorthist carefully fits them. Follow-up care is essential to assure the shoe/orthosis continues to perform as prescribed.
Filling a prescription includes measuring the foot, and may include taking a foot impression. The two basic elements of fit are shape and size. A shoe's shape - rounded versus squared toe, for example - must match the foot's shape. Once the correct shape is identified, size is determined by measuring length, arch and width.
Because a foot orthosis can only be worn with a shoe, it is imperative that the foot, orthosis and shoe be treated as a unit. Only then can the doctor and the patient rest assured the orthosis will be effective.
What to Look For
When a shoe is made, its upper shaped around a model called a "last". Manufacturers make their own lasts, which is one reason why size differs even when shoes look similar. The wear and tear on a shoe reflect patterns of movement, showing a credentialed pedorthist where problems like blisters or ulcers are most likely to start.
When selecting shoes, patients need to keep shape and foot measurement in mind. Another consideration is the activities shoes are being purchased for, the level and frequency of the activities, and whether the foot's major need(s) will be for protection, accommodation or support.
Shoe sizes are not absolute. A size 8 by one manufacturer can be 7-1/2 or 8-1/2 in another's product. Size also varies with style, so shoes should always be chosen by fit, not by "size." Ideally, shoes should be fit during the time of day they'll be worn. Walkers, for example, should shop for walking shoes after a walk; golfers should shop for golf shoes around their regular tee times.
For health reasons, people should generally look for shoes with a stable, resilient sole and a leather or fabric upper section, because both materials "breathe," allowing air to reach the foot. Air circulation helps prevent growth of fungus or bacteria.
There should be roughly a thumb width of space between the longest toe and the end of the shoe when the wearer is standing - the extra space accommodates feet as they expand during motion. The heel area should not chafe or pinch the foot. Shoes with lacing or other fastening allow adjustability, which can be important for people with diabetes.
The Wearer's Responsibility
It's a mistake to assume a shoe can be "broken in." If a shoe isn't comfortable at the try-on stage, it can distort the foot. It's important to remember that foot size changes, both during daily activities and throughout adulthood, becoming wider and longer with use. The shoe that feels fine at 9:00 a.m. may not feel fine by 9:00 p.m. The shoe size that seems appropriate at age 18 will most likely be too small when the wearer turns 30; what fits at 30 probably won't at 50.
But being a well-educated consumer isn't enough. People with diabetes must examine their feet daily, and be willing to tell their credentialed pedorthist immediately if they see a problem begin. Diabetic foot health calls for a team approach, and the patient is the ultimate team leader.
The Footwear Specialist
When a standard shoe won't accommodate an individual's needs, a credentialed pedorthist can recommend a different type or style, modify the shoe, or even construct one from a last of the patient's foot. In cases of severe injury and partial amputation, such tailoring is often prescribed.
A foot orthosis can be fabricated from a variety of materials. Credentialed pedorthists are qualified to determine the materials appropriate for a condition and its prescription. They know what will perform most effectively, and how long the materials can be expected to function as prescribed. The credentialed pedorthist is a footwear specialist who works with the patient to make sure shoes and foot orthoses, instead of being part of the problem, are part of the healthy solution.
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