Diabetic shoe

Last updated

Many diabetic shoes have velcro closures for ease of application and removal. Diabetic shoes.jpg
Many diabetic shoes have velcro closures for ease of application and removal.

Diabetic shoes (sometimes referred to as extra depth, therapeuticshoes or sugar shoes) are specially designed shoes, or shoe inserts, intended to reduce the risk of skin breakdown in diabetics with existing foot disease and relieve pressure to prevent diabetic foot ulcers.

People with diabetic neuropathy in their feet may have a false sense of security as to how much at risk their feet actually are. [1] An ulcer under the foot can develop in a couple of hours. The primary goal of therapeutic footwear is to prevent complications, which can include strain, ulcers, calluses, or even amputations for patients with diabetes and poor circulation. [2] Neuropathy can also change the shape of a person's feet, which limits the range of shoes that can be worn comfortably. [3] In addition to meeting strict guidelines, diabetic shoes must be prescribed by a physician and fit by a certified individual, such as an orthotist, podiatrist, therapeutic shoe fitter, or pedorthist. The shoes must also be equipped with a removable orthosis. Foot orthoses are devices such as shoe inserts, arch supports, or shoe fillers such as lifts, wedges and heels. The diabetic shoes and custom-molded inserts work together as a preventive system [4] to help diabetics avoid foot injuries and improve mobility. [5] [6]

The evidence for special footwear to treat diabetic foot ulcers is poor [7] but their effectiveness for prevention is well-established. [8] [9] [10] Design features of footwear that are effective in reducing pressure are arch supports, cushioned cut-outs around points at risk of damage, and cushioning at the ball of the foot. Technology for measuring the pressure within the shoes is recommended during designing diabetic footwear. [11] [12]

In the United States, diabetic shoes can be covered by Medicare. [13]

Related Research Articles

Callus Thickened and hardened area of skin

A callus is an area of thickened and sometimes hardened skin that forms as a response to repeated friction, pressure, or other irritation. Since repeated contact is required, calluses are most often found on the feet and hands, but they may occur anywhere on the skin. Some degree of callus, such as on the bottom of the foot, is normal.

<span class="mw-page-title-main">Hyperbaric medicine</span> Medical treatment at raised ambient pressure

Hyperbaric medicine is medical treatment in which an ambient pressure greater than sea level atmospheric pressure is a necessary component. The treatment comprises hyperbaric oxygen therapy (HBOT), the medical use of oxygen at an ambient pressure higher than atmospheric pressure, and therapeutic recompression for decompression illness, intended to reduce the injurious effects of systemic gas bubbles by physically reducing their size and providing improved conditions for elimination of bubbles and excess dissolved gas.

Wound Acute injury from laceration, puncture, blunt force, or compression

A wound is a rapid onset of injury that involves lacerated or punctured skin, or a contusion from blunt force trauma or compression. In pathology, a wound is an acute injury that damages the epidermis of the skin.

Diabetic neuropathy refers to various types of nerve damage associated with diabetes mellitus. Symptoms depend on the site of nerve damage and can include motor changes such as weakness; sensory symptoms such as numbness, tingling, or pain; or autonomic changes such as urinary symptoms. These changes are thought to result from microvascular injury involving small blood vessels that supply nerves. Relatively common conditions which may be associated with diabetic neuropathy include distal symmetric polyneuropathy; third, fourth, or sixth cranial nerve palsy; mononeuropathy; mononeuropathy multiplex; diabetic amyotrophy; and autonomic neuropathy.

<span class="mw-page-title-main">Pressure ulcer</span> Skin ulcer (bed sore)

Pressure ulcers, also known as pressure sores, bed sores or pressure injuries, are localised damage to the skin and/or underlying tissue that usually occur over a bony prominence as a result of usually long-term pressure, or pressure in combination with shear or friction. The most common sites are the skin overlying the sacrum, coccyx, heels, and hips, though other sites can be affected, such as the elbows, knees, ankles, back of shoulders, or the back of the cranium.

Electrotherapy Use of electricity for medical purposes

Electrotherapy is the use of electrical energy as a medical treatment. In medicine, the term electrotherapy can apply to a variety of treatments, including the use of electrical devices such as deep brain stimulators for neurological disease. The term has also been applied specifically to the use of electric current to speed wound healing. Additionally, the term "electrotherapy" or "electromagnetic therapy" has also been applied to a range of alternative medical devices and treatments.

Sucralfate

Sucralfate, sold under various brand names, is a medication used to treat stomach ulcers, gastroesophageal reflux disease (GERD), radiation proctitis, and stomach inflammation and to prevent stress ulcers. Its usefulness in people infected by H. pylori is limited. It is used by mouth(for upper GIT ulcers) and rectally(for radiation proctitis).

The term diabetes includes several different metabolic disorders that all, if left untreated, result in abnormally high concentration of a sugar called glucose in the blood. Diabetes mellitus type 1 results when the pancreas no longer produces significant amounts of the hormone insulin, usually owing to the autoimmune destruction of the insulin-producing beta cells of the pancreas. Diabetes mellitus type 2, in contrast, is now thought to result from autoimmune attacks on the pancreas and/or insulin resistance. The pancreas of a person with type 2 diabetes may be producing normal or even abnormally large amounts of insulin. Other forms of diabetes mellitus, such as the various forms of maturity onset diabetes of the young, may represent some combination of insufficient insulin production and insulin resistance. Some degree of insulin resistance may also be present in a person with type 1 diabetes.

<span class="mw-page-title-main">Shoe insert</span>

A removable shoe insert, otherwise known as a foot orthosis, insole or inner sole accomplishes many purposes, including daily wear comfort, height enhancement, plantar fasciitis treatment, arch support, foot and joint pain relief from arthritis, overuse, injuries, leg length discrepancy, and other causes such as orthopedic correction and athletic performance.

People with diabetes have a greater chance of developing neuropathy, vascular disease, and infections, especially in the legs, so socks and footwear that reduce or eliminate pressures or hot spots is important. A diabetic sock is a non-restrictive, but close fitting sock which is designed to alleviate pressures on the foot or leg. Typically sufferers of diabetes are the most common users of this type of sock. Diabetes raises the blood sugar level, which can increase the risk of foot ulcers. Diabetic socks are made to be non-restrictive to circulation, but if inclusive of Medical Grade, FDA regulated gradient compression, they may include venous compression for enhanced blood circulation.

Transdermal Continuous Oxygen Therapy is a wound closure technique for chronic and acute wounds which blankets a wound in oxygen on a 24-hour basis until the wound heals. Unlike hyperbaric oxygen treatment for chronic wounds, oxygen treatment used in this therapy is not systemic in nature and treats only the wound area. This treatment differs from topical oxygen treatments, as topical oxygen typically involves sporadic treatments of 1–3 hours several times per week, while TCOT treatment is 24/7 by nature.

Complications of diabetes mellitus include problems that develop rapidly (acute) or over time (chronic) and may affect many organ systems. The complications of diabetes can dramatically impair quality of life and cause long-lasting disability. Overall, complications are far less common and less severe in people with well-controlled blood sugar levels. Some non-modifiable risk factors such as age at diabetes onset, type of diabetes, gender and genetics may influence risk. Other health problems compound the chronic complications of diabetes such as smoking, obesity, high blood pressure, elevated cholesterol levels, and lack of regular exercise. Complications of diabetes are a strong risk factor for severe COVID-19 illness.

<span class="mw-page-title-main">Orthotics</span> Medical specialty that focuses on the design and application of orthoses

Orthotics is a medical specialty that focuses on the design and application of orthoses. An orthosis is "an externally applied device used to influence the structural and functional characteristics of the neuromuscular and skeletal system".

<span class="mw-page-title-main">Diabetic foot</span> Medical condition

A diabetic foot is any pathology that results directly from peripheral arterial disease (PAD) and/or sensory neuropathy affecting the feet in diabetes mellitus; it is a long-term complication of diabetes mellitus. Presence of several characteristic diabetic foot pathologies such as infection, diabetic foot ulcer and neuropathic osteoarthropathy is called diabetic foot syndrome. The resulting bone deformity is known as Charcot foot.

<span class="mw-page-title-main">Diabetes</span> Group of metabolic disorders

Diabetes mellitus, commonly known as diabetes, is a group of metabolic disorders characterized by a high blood sugar level (hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased appetite. If left untreated, diabetes can cause many health complications. Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death. Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, damage to the nerves, damage to the eyes and cognitive impairment.

Petr Hlaváček

Petr Hlavacek was a Czech shoe expert, university lecturer and researcher. His professional focus was to study the preparation and production of shoe materials, footwear, footwear ergonomics and historical footwear.

<span class="mw-page-title-main">Diabetic foot ulcer</span> Medical condition

Diabetic foot ulcer is a major complication of diabetes mellitus, and probably the major component of the diabetic foot.

Total contact casting (TCC) is a specially designed cast designed to take weight off of the foot (off-loading) in patients with diabetic foot ulcers (DFUs). Reducing pressure on the wound by taking weight off the foot has proven to be very effective in DFU treatment. DFUs are a major factor leading to lower leg amputations among the diabetic population in the US with 85% of amputations in diabetics being preceded by a DFU. Furthermore, the five-year post-amputation mortality rate among diabetics is estimated at 45% for those with neuropathic DFUs.

Diabetic foot infection Medical condition

Diabetic foot infection is any infection of the foot in a diabetic person. The most frequent cause of hospitalization for diabetic patients is due to foot infections. Symptoms may include pus from a wound, redness, swelling, pain, warmth, tachycardia, or tachypnea. Complications can include infection of the bone, tissue death, amputation, or sepsis. They are common and occur equally frequently in males and females. Older people are more commonly affected.

Nachiappan Chockalingam, professionally known as Nachi Chockalingam is a British scientist, academic practitioner and expert in Clinical Biomechanics. He is a professor at Staffordshire University and a Fellow of the Institute of Physics and Engineering in Medicine and has been appointed to a panel of experts for the Research Excellence Framework. Between 2016 and 2022, he has contributed to the NIHR Research for Patient Benefit Panel and serves in multiple other review panels of global grant awarding bodies including the EPSRC, MRC and the European Commission. He contributed to development of podiatric biomechanics in the UK and played a pivotal role in the establishment of the journals such as the Footwear Science and is on the editorial panel for a number of scientific and clinical journals.

References

  1. Foot Complications, from the American Diabetes Association; first published no later than November 4, 2009 (as per archive.org); retrieved November 1, 2013.
  2. Diabetic Foot Care at ePodiatry; published 2003; retrieved September 6, 2011.
  3. DeMello M (September 10, 2009). Feet and Footwear: A Cultural Encyclopedia. Macmillan. pp. 92–94. ISBN   9780313357145.
  4. Chatzistergos PE, Gatt A, Formosa C, Farrugia K, Chockalingam N (June 2020). "Optimised cushioning in diabetic footwear can significantly enhance their capacity to reduce plantar pressure" (PDF). Gait & Posture. 79: 244–250. doi:10.1016/j.gaitpost.2020.05.009. PMID   32454304. S2CID   218911847.
  5. Healy A, Naemi R, Chockalingam N (July–August 2013). "The effectiveness of footwear as an intervention to prevent or to reduce biomechanical risk factors associated with diabetic foot ulceration: a systematic review". Journal of Diabetes and Its Complications. 27 (4): 391–400. doi:10.1016/j.jdiacomp.2013.03.001. PMID   23643441.
  6. Healy A, Naemi R, Chockalingam N (September 18, 2014). "The effectiveness of footwear and other removable off-loading devices in the treatment of diabetic foot ulcers: a systematic review". Current Diabetes Reviews. 10 (4): 215–230. doi:10.2174/1573399810666140918121438. PMID   25245020.
  7. Healy A, Naemi R, Chockalingam N (September 18, 2014). "The effectiveness of footwear and other removable off-loading devices in the treatment of diabetic foot ulcers: a systematic review". Current Diabetes Reviews. 10 (4): 215–230. doi:10.2174/1573399810666140918121438. PMID   25245020.
  8. Bus SA, van Deursen RW, Armstrong DG, Lewis JE, Caravaggi CF, Cavanagh PR (January 2016). "Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review". Diabetes/Metabolism Research and Reviews. 32 Suppl 1: 99–118. doi:10.1002/dmrr.2702. PMID   26342178. S2CID   24862853.
  9. Heuch L, Streak Gomersall J (July 2016). "Effectiveness of offloading methods in preventing primary diabetic foot ulcers in adults with diabetes: a systematic review". JBI Database of Systematic Reviews and Implementation Reports. 14 (7): 236–265. doi:10.11124/JBISRIR-2016-003013. PMID   27532798. S2CID   12012686.
  10. van Netten JJ, Raspovic A, Lavery LA, Monteiro-Soares M, Rasmussen A, Sacco IC, Bus SA (March 2020). "Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review" (PDF). Diabetes/Metabolism Research and Reviews. 36 Suppl 1 (S1): e3270. doi:10.1002/dmrr.3270. PMID   31957213. S2CID   210830578.
  11. Collings R, Freeman J, Latour JM, Paton J (January 2021). "Footwear and insole design features for offloading the diabetic at risk foot-A systematic review and meta-analyses". Endocrinology, Diabetes & Metabolism. 4 (1): e00132. doi:10.1002/edm2.132. PMC   7831212 . PMID   33532602.
  12. "Bespoke shoes and insoles could prevent foot ulcers in people with diabetes". NIHR Evidence (Plain English summary). National Institute for Health and Care Research. August 5, 2020. doi:10.3310/alert_40657. S2CID   241787869.
  13. Therapeutic Shoes or Inserts, from medicare.gov. Accessed November 1, 2013.

See also