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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, chappal, and custom-molded inserts work together as a preventive system [4] to help diabetics avoid foot injuries and improve mobility. [5] [6] [7]
Diabetic foot ulcer is a breakdown of the skin and sometimes deeper tissues of the foot that leads to sore formation. It is thought to occur due to abnormal pressure or mechanical stress chronically applied to the foot, usually with concomitant predisposing conditions such as peripheral sensory neuropathy, peripheral motor neuropathy, autonomic neuropathy or peripheral arterial disease. [1]
Duration and aggressiveness of offloading (non-weight-bearing vs. weight-bearing, non-removable vs. removable device) should be guided by clinical assessment of healing of neuropathic arthropathy based on edema, erythema, and skin temperature changes. [10] It can take six to nine months for the edema and erythema of the affected joint to recede.
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Diabetic neuropathy is implicated in 50–75% of nontraumatic amputations. The main risk factor for diabetic neuropathy is hyperglycemia. In the DCCT (Diabetes Control and Complications Trial, 1995) study, the annual incidence of neuropathy was 2% per year but dropped to 0.56% with intensive treatment of Type 1 diabetics.
Footwear and orthotics are most effective in neuromas that have existed less than four and a half months and are smaller than 4–5 millimetres (0.16–0.20 in). To prevent or treat Morton's neuroma, comfortable shoes that are sufficiently long and have a wide toe box, flat heel, and thick sole are recommended. [3]
An example is compensating for a leg length discrepancy, equivalent to replacing a missing part of a limb. Another example is the replacement of the forefoot after a forefoot amputation. This treatment is often made from a combination of a prosthesis to replace the forefoot and an orthosis to replace the lost muscular function (ortho prosthesis).
One week after a biopsy confirmed the diagnosis, doctors amputated Basil’s pinky toe on her right foot to stop the cancer from spreading. “It just totally took me just by surprise,” she said.
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