Diabetes Mellitus is a chronic process that occurs when the pancreas does not produce enough insulin or when the body does not efficiently use the insulin it produces. One of the parts of the body that can be affected by this disease is the foot, giving rise to what we know as the Diabetic Foot.
Diabetes is a clinical disorder with a neuropathic base and induced to maintain glucose levels higher than usual, characterised by a decrease in sensitivity in the foot (neuropathy) and a decrease in blood supply (ischemia). Both factors can predispose the appearance of an ulceration in the foot
Here at Happy Feet Pedorthics we can help you find the best option for you, we’ll assist you in the selection of shoes for your daily routine, shoes that will keep your feet safe. Measuring your feet is the first step in order to make your new shoes fit accurately, then we will recommend the most comfortable design for you.
“About 15% of diabetic patients develop some foot ulcer throughout their life.”
Diabetes is the most common cause of amputation of the lower limb in developed countries and it is estimated that the number of diabetic patients diagnosed will increase significantly. Many of these amputations could be avoided if the necessary preventive actions were taken.
Preventive measures
It is recommended to perform neuropathic and vasculopathy screening once a year to check the status / evolution of the disease, and in at-risk patients every six months. Likewise, the use of customised templates from a complete biomechanical study avoids the appearance of any potential problem derived from said alterations.
It is important to convey the message that being diabetic does not mean that you have to have an ulceration or amputation in your foot. What is necessary is to carry out the necessary preventive actions in order to anticipate the appearance of the ulcer. This is achieved by conducting a neuropathic and vascular study.
What is this study?
Different tests are carried out in order to determine the degree of involvement in the sensitivity of the foot and the degree of blood supply.
The proofs are the following:
- Sensibility exploration. Diabetic neuropathy
By means of the use of certain devices the degree of affection of the sensibility in the foot that the patient has is diagnosed. Both deep and superficial sensitivity are evaluated.
It is very important to detect early the decrease in sensitivity (neuropathy) to establish prevention plans that can avoid problems in the patient and to monitor the neuropathy affection over time. Through a tuning fork and monofilament, deep or proprioceptive inspection is carried out.
- Vascular exploration. Diabetic vasculopathy
This exploration allows us to assess the state of the blood supply received by the foot with the aim of being able to refer the patient to the vascular doctor in the necessary cases. It is done using a device called Doppler.
- Baropodometric study
It helps us to predict what can happen (appearance of an ulcer, injury and even amputation) by obtaining the static and dynamic analysis of the patient’s plantar pressures and diagnosing potential problems derived from excess pressure in certain areas of the sole of the foot.
Biomechanical study of the footprint (left) and Result of study of plantar pressures on diabetic patient without insoles. If we know that the main cause of ulceration is the pressure maintained at a particular point of the foot and if we are able to detect those pressure points before the ulcer forms and using a personalised template to eliminate the overload points, we will be minimising the risk of ulceration greatly.
- Prescription and manufacture of custom templates
It is important to obtain a virtual mould of the foot with total precision. Later it is designed in the engineering department and the template is manufactured in a robotic way, using specific materials that allow to eliminate the points of overload detected in the foot.
The objective of a personalised template is:
- Redistribution of pressures
- Containment of deformities
- Compensation of biometric lacerations
- Recommendation of footwear
It is very important that the diabetic patient take extreme precautions regarding footwear. Below we detail the most relevant aspects regarding the characteristics of the footwear:
- Correct adaptation of the insole to footwear
- That the shoes do not press or mismatch and be lightweight
- Numbering according to forefoot width
- The blade should be wide and high (preferably lycra)
- The interior should not have seams
- The sole has to be rubber and non-slip
- The heel should have 2-3 cm
- Lace-up or Velcro shoes
- Semi-rigid buttress
- Shoe cutting materials must be breathable (skin preferably)
It is important to understand that the fact of suffering diabetes should not relate directly to suffer problems of ulcerations or amputations in the feet, far from it. The important thing is to understand that the feet are a sensitive part in this type of patients and that it is convenient to make the appropriate revisions with the appropriate means to be able to carry out all the necessary preventive actions to avoid any complication.
Our advice is to go periodically to the podiatrist to perform inspection and care of the foot (correct nail cutting, calluses delamination, helomas treatments, etc) and once a year repeat the neuropathic and vascular study to assess the evolution of the possible Vasculopathy and neuropathy to perform the necessary preventive actions.
Remember that you need to take care of your feet since they have an important impact in any activity you carry out throughout the day. Contact us today to know more about tailor-made shoes for your health.
Here at Happy Feet Pedorthics we can help you find the best option for you, we’ll assist you in the selection of shoes that are comfortable at the same time they are great for your health. You will improve your daily activities consistently and ensure you remain comfortable and relaxed knowing your feet are protected all the time.