The Diabetic Foot:Relevance to Therapeutic

Footwear Design

Diabetes is a condition where the Diabetes is a condition where the body is unable to automatically body is unable to automatically regulate blood glucose levels, regulate blood glucose levels, resulting in too much glucose (a resulting in too much glucose (a sugar) in the bloodsugar) in the blood

The blood glucose level is regulated The blood glucose level is regulated with the help of insulin, a hormone with the help of insulin, a hormone (or chemical messenger) made in the (or chemical messenger) made in the pancreas.pancreas.

What is Diabetes?

Insulin is the key that glucose Insulin is the key that glucose needs to enter the body’s cells needs to enter the body’s cells so that it can be used as fuel.so that it can be used as fuel.

Diabetes develops when the Diabetes develops when the pancreas stops producing insulin pancreas stops producing insulin (Type 1 diabetes) or when the (Type 1 diabetes) or when the body does not respond properly body does not respond properly to insulin (Type 2 diabetes).to insulin (Type 2 diabetes).

What is Diabetes?

Initially insulin is still produced by Initially insulin is still produced by the pancreas, but is less effective the pancreas, but is less effective than normal.than normal.

This is called insulin resistance and This is called insulin resistance and is an inherited characteristic made is an inherited characteristic made worse by obesity and a sedentary worse by obesity and a sedentary life style.life style.

Type 2 Diabetes

Because insufficient insulin Because insufficient insulin is available for glucose to move from is available for glucose to move from the blood stream into the body cells the blood stream into the body cells and the liver, excess glucose remains and the liver, excess glucose remains in the blood stream resulting in in the blood stream resulting in higher than normal blood glucose higher than normal blood glucose levels (BGLs).levels (BGLs).

Type 2 Diabetes

After years of poor eating habits and a After years of poor eating habits and a sedentary life style, the pancreas may sedentary life style, the pancreas may become “exhausted” and produce less become “exhausted” and produce less insulin. insulin.

Early symptoms include thirst, tiredness Early symptoms include thirst, tiredness and/or frequent urination. and/or frequent urination.

Without proper blood glucose control, Without proper blood glucose control, diabetes can cause blurred vision, kidney diabetes can cause blurred vision, kidney disease, poor circulation, numbness, foot disease, poor circulation, numbness, foot ulcers, and premature death. ulcers, and premature death.

Type 2 Diabetes

Diabetes Continues to Rise

Key findings from the National Diabetes Statistics Report, 2014 (based on health data from 2012), include:

•29 million people in the United States (9.3 percent) have diabetes. Majority are type 2 diabetics.

•1.7 million people aged 20 years or older were newly diagnosed with diabetes in 2012.

•Non-Hispanic black, Hispanic, and American Indian/Alaska Native adults are about twice as likely to have diagnosed diabetes as non-Hispanic white adults.

•208,000 people younger than 20 years have been diagnosed with diabetes (type 1 or type 2).

•86 million adults aged 20 years and older have prediabetes.

Diabetic foot ulcers are sores on Diabetic foot ulcers are sores on the feet that occur in 20% of the feet that occur in 20% of diabetic patients some time during diabetic patients some time during their lifetime. their lifetime.

The risk of lower-extremity The risk of lower-extremity amputation is increasedamputation is increased 8-fold8-fold in in these patients once an ulcer these patients once an ulcer develops.develops.

Diabetic Foot Ulcers

Diabetic foot ulcers are caused by Diabetic foot ulcers are caused by neuropathic (nerve) and vascular (blood neuropathic (nerve) and vascular (blood vessel) complications of the disease.vessel) complications of the disease.

Nerve damage due to diabetes causes Nerve damage due to diabetes causes altered or complete loss of feeling in the altered or complete loss of feeling in the foot and/or leg. This is known as foot and/or leg. This is known as peripheral neuropathy. Pressure from peripheral neuropathy. Pressure from shoes, boney deformity, or any injury to shoes, boney deformity, or any injury to the foot may go unnoticed. the foot may go unnoticed.

The loss of protective sensation stops the The loss of protective sensation stops the patient from being warned that the skin is patient from being warned that the skin is being injured and may result in skin loss, being injured and may result in skin loss, blisters and ulcers.blisters and ulcers.

Diabetic Foot Ulcers

Ulcers untreated can lead to the Ulcers untreated can lead to the amputation cycle with eventual loss of amputation cycle with eventual loss of the limb. the limb.

Statistics show a very high morbidity Statistics show a very high morbidity for these individuals once this for these individuals once this happens. happens.

So... a diabetic ulcer on the foot is a So... a diabetic ulcer on the foot is a high risk for loss of life and thus must high risk for loss of life and thus must be prevented.be prevented.

Diabetic Foot Ulcers

Diabetes causes slow wound healing Prevention of ulcers is key

Inadequate footwear independently Inadequate footwear independently tripled amputation risk.tripled amputation risk.

Education of professionals and Education of professionals and patients, particularly about footwear patients, particularly about footwear and foot care, coupled with improved and foot care, coupled with improved diabetes clinical care, is key to diabetes clinical care, is key to reducing amputation riskreducing amputation risk

Therapeutic FootwearTherapeutic Footwear saves lives saves lives

EXERCISE IS EXERCISE IS MEDICINEMEDICINE

Obesity and a sedentary lifestyle are Obesity and a sedentary lifestyle are high risk factors in diabeteshigh risk factors in diabetes

EXERCISE IS MEDICINE.. As simple EXERCISE IS MEDICINE.. As simple as walking.. But wearing the as walking.. But wearing the correctly fitted therapeutic shoe is correctly fitted therapeutic shoe is imperativeimperative

Therapeutic Footwear FeaturesTherapeutic Footwear Features

Closure systems: To protect from pressure on the dorsum  of Closure systems: To protect from pressure on the dorsum  of the foot. Padded tongues secured by lace, Velcro straps and tie-the foot. Padded tongues secured by lace, Velcro straps and tie-less lace. less lace.

Ventilation: Mesh and/or leather uppers to enhance airflow.

Midsole: Foam material that provides excellent cushioning to reduce pressure on the balls of the feet.

Outsole: Must offer grip to prevent falls. Rubber is excellent.

Stability: Important to reduce the stress on the ligaments and tendons in those that over or under-pronate.

Weight: A lighter shoe causes less energy used.

BEST STABILITY SHOESBEST STABILITY SHOES All our PDAC approved New Balance and All our PDAC approved New Balance and

Brook’s shoes offer technological design Brook’s shoes offer technological design features designed to control excessive features designed to control excessive rearfoot and midfoot motion. rearfoot and midfoot motion.

Stabilizing the diabetic foot reduces stress Stabilizing the diabetic foot reduces stress while slowing the progression of joint while slowing the progression of joint subluxation and subsequent high pressure subluxation and subsequent high pressure areas. areas.

The NB 813 is our most popular walking The NB 813 is our most popular walking shoe and features a rollbar on both sides shoe and features a rollbar on both sides of the heel for enhanced stability. of the heel for enhanced stability.

Best Extra-Depth Best Extra-Depth ShoesShoes

Our Nature’s Stride Our Nature’s Stride and Orthofeet shoes and Orthofeet shoes are excellent choices are excellent choices when extra room is when extra room is needed. needed.

For the high risk For the high risk diabetic foot with foot diabetic foot with foot deformities or deformities or swelling.swelling.

Ideal for toe-fills and Ideal for toe-fills and custom diabetic custom diabetic inserts for off-loading inserts for off-loading to prevent ulceration.to prevent ulceration.

Best Shoes for Best Shoes for PTTDPTTD

Diabetics are prone to Diabetics are prone to developing Posterior Tibial developing Posterior Tibial Tendon Dysfunction. Tendon Dysfunction.

Boots provide higher support Boots provide higher support up the ankle to lessen the up the ankle to lessen the stress on a weak or strained stress on a weak or strained Posterior Tibial Tendon. Great Posterior Tibial Tendon. Great for people that do not want to for people that do not want to wear an AFO. wear an AFO.

Dia-Foot carries a number of Dia-Foot carries a number of boots in our catalog to choose boots in our catalog to choose from. from.

Wolverine Wolverine Harrison BootHarrison Boot

For severe For severe swelling/Deformitiesswelling/Deformities

Our elastic spandex Our elastic spandex Orthofeet shoes Orthofeet shoes stretches and conforms stretches and conforms to the foot.to the foot.

Eases pressure on foot Eases pressure on foot deformities causing deformities causing great protection for the great protection for the diabetic foot. diabetic foot.

Always Assist your Patient with Always Assist your Patient with Choosing the Right ShoeChoosing the Right Shoe

Your patient may select a boat shoe Your patient may select a boat shoe but if your patient has severe foot but if your patient has severe foot deformities, then that would provide a deformities, then that would provide a poor fit. poor fit.

knowledge of the shoes will help you knowledge of the shoes will help you have more success in helping your have more success in helping your patient pick the right shoe.patient pick the right shoe.