September 2009

Klaveness Medical ShoesForefoot & Heel Relief Shoes for Diabetic Foot Care

WorldwideLimb Loss

1 million per year due to diabetes1 amputation every 30 seconds

Jeffcoate & BakkerLancet, April 30, 2005

Prevalence of Diabetes Rising

Increase in Amputations

Ulceration

Significant Economic Costs

Prolonged Hospital Time - Extended Rehabilitation - Increased Home Care -

Increased Social Service Costs

✤ Inpatient Care (37% of Total Costs)

✤ Topical Treatment of Wounds (45% of Total Costs)

Costs of Healing Ulcers

Costs of Antimicrobial Drugs, Outpatient Visits and Orthotic Devices Very Small in Comparison

37%

45%

18%

Long Term Perspective

✤ Foot Ulcers tend to Recur

✤ 31% within 1 Year

✤ 61% within 3 Years

✤ 70% within 5 years

Costs of Foot UlcerationNon-Ischaemic Lesions $16,437

Ischaemic Lesions $27,203

Costs of Amputation

✤ Economic Costs

✤ Minor Lower Extremity (foot level) $43,800

✤ Major Lower Extremity (above ankle) $66,215

77% of the Costs Occur AFTER the Amputation

Costs of Foot UlcerationNon-Ischaemic Lesions $16,437

Ischaemic Lesions $27,203

“Focusing on prevention becomes cost-effective if we could reduce the incidence of foot ulcers and amputation by just

25%”

Boulton et al “The global burden of diabetic foot disease”Lancet, Nov 2006

Neuropathic Foot

"The whole problem is one of mechanics, not of medicine”

“ The biological responses to these denervated limbs are qualitatively similar

to those of normal limbs”

It is the permitted pattern of mechanical stress that is different"

Paul Brand

“Its not what you put on a diabetic foot ulcer - its what you take off”

Armstrong et al Clinical Infectious Diseases, Vol 39, 2004

Pressure and Tissue Shear are Critical FactorsShoes and Orthoses are the Means of Influence

Consequences of mechanical effects can be severe

Advised amputation

Three years to resolve

Management Strategy

✤ Depends on individual patient risk level

✤ Can use different tools and techniques

Purpose of Orthoses and Shoes

✤ Protection from further tissue breakdown

✤ Prophylaxis - taking measures to avoid future tissue breakdown

✤ Pressure Relief

✤ Ambulant Relief from Pressure, Friction and Shear at areas of Risk

✤ Recumbent

Ambulant Devices and Techniques

✤ PRAFO

✤ Heel-Relief Shoes

✤ Forefoot Relief Shoes

✤ AirCast

✤ Axial Offloading Orthoses

✤ Total Contact Cast

For Off-loading Of The Calcaneal/Heel Area

Heel-Relief ShoesKlaveness Medical Shoes

FEATURESKlaveness Medical Shoes

Neuro-ischaemic Heel Ulcer Five Months later

Features & Benefits

•Designed to offload the heel/calcaneal area

•Protected mobility

•Quality materials & competitive price

•Replaceable footbed

•Trimable straps

•Biomechanically sound design

Forefoot ReliefKlaveness Medical Shoes

For Off-loading Of The Forefoot/Metatarsal Area

Forefoot ReliefNeuropathic forefoot lesion

Neuropathic forefoot lesion after 3 months

FOREFOOT RELIEF SHOE

FEATURESKlaveness Medical Shoes

Features & Benefits

•Designed to offload the forefoot area

•Protected mobility

•Quality materials & competitive price

•Replaceable footbed

•Trimable straps

•Biomechanically sound design

Conclusion

Shoes that improve on a proven approach to offloading the heel or

forefoot