An article by Dr Les Bailey phd, DO, Acopm, Apta ( int part ).. Dr Les Bailey, Woodmansterne, Banstead, Surrey.
Author of "the laymans guide to foot and heel pain"
A Dr Les Bailey orthotics article.
Dr Les Bailey physical therapies clinics, Woodmansterne, Banstead, Surrey.
The diabetic foot is a special case for orthotics for a number of reasons, mainly preventative.
Diabetic feet are at risk from skin ulceration, osteomyelitis, fractures, and arthropathy.
The source of these risks is due to both necrosis and neuropathy.
The role of orthotics is to rebalance the pressures on the foot , so that the pressure is shared evenly and there are no spots where there is excess rubbing or concentrated pressure.
Prescription orthotics are recognised in the effective management of the diabetic foot , particularly for preventing trauma, ulceration, and related problems.
They also stop excess internal stress to the musculoskeletal structure of the foot by controlling faulty biomechanics.
It has been suggested by trials, that the wearing of prescription orthotics reduces the risk of ulcer reoccurence by over half.
The non diabetic foot is able to resist the rigours of normal everyday activity viz pressure and friction, however, the diabetic foot can be subject to localised ischaemia, and resulting necrosis.
Prescription orthotics ( sometimes with specially adapted shoes ) minimise compressive forces by sharing the load between the whole plantar surface of the foot evenly, thus avoiding local areas of stress and preventing ulcer formation.
It must also be borne in mind that the diabetic foot is subject to abnormalities of bone / joint structure, causing prominent areas that are subject to massive pressure upon ground striking.
The most common of these is exposed metatarsal heads and claw toes resulting from hyperextension of the foot muscles.
This occurs when there is muscle atrophy due to neuropathy.
There is also a high incidence of metatarsal pad migration in the diabetic foot, meaning that the ball of the foot is left without its natural padding.
The problem with prescribing orthotics for the diabetic foot comes from having to have enough rigidity to control the faulty biomechanics versus necessitating being soft enough to pad the foot well and prevent problems with ulceration and necrosis.
It is sods law that the diabetic arrives for orthotics because of another problem eg plantar fasciitis, that requires good biomechanical control. Therefore this creates the conundrum of softness versus rigidity.
Luckily, nowadays, the manufacturers make a 1.5mm thick shelling material, that is pretty useless on its own, but when combined with an arch infill of semi pliable foam, ensures we can get proper control WITH soft padding.
Coupled with this, there are now long lasting top cover materials from which to have metatarsal accomodations etc built in.
The challenge for the prescriber when faced with a diabetic foot is always getting biomechanical control versus necrosis / ulcer prevention.
The above should amply illustrate why prefabricated orthotics should be avoided like the plague, and this is especially true for the diabetic foot.
Dr Les Bailey phd, DO, Acopm, Apta (int part )
Dr Les Bailey, Woodmansterne, Banstead, Surrey
About Dr Les Bailey phd,DO, acopm.apta(int part)
Author of "The laymans guide to foot and heel pain"
Email direct. drlesbailey@
Mobile telephone. number 07801418080
Dr Les Bailey began his career in the physical therapies field in 1981,qualifying first in remedial massage,and going on to qualify as an osteopath.
OIUCM awarded him his phd for a thesis on the treatment of plantar fasciitis using prescription orthotics.
He was awarded the teaching/lecturing diploma at the northern school of osteopaths in 1993.
He also holds a diploma in foot biomechanics .
Dr Les Bailey works from his clinic near Banstead in surrey.