Abstract
Complications of diabetes such as neuropathy, tissue glycosylation, Charcot neuropathic osteoarthropathy and minor foot amputations all cause changes in the normal architecture and biomechanics of the foot. Deformity leads to areas of abnormal pressure load and the peak pressures at these points can be in excess of 1000 kPa. The repetitive pressure insult and associated shear stress eventually lead to tissue loss and ulceration if not corrected.
Off-loading is one of the integral facets of management of the diabetic foot. Currently there is a paradox between footwear that is aesthetically acceptable to patients and footwear which provides maximal pressure reduction. The therapeutic shoes and temporary footwear used in many diabetic foot clinics have poor pressure reduction, yet patients have poor compliance with removable, but more effective footwear. Non-removable, below knee devices are the gold standard and are now also recommended in patients with mild infection or ischaemia.
Consideration of biomechanics when performing minor amputations can minimise the future risk from these. Other surgical off-loading strategies are discussed for those who fail to respond to conventional non-surgical measures.
A skilled orthotist is a vital member of the diabetes limb salvage multidisciplinary team.
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Jones, A.D., Russell, D.A. (2023). Foot Deformity and Pressure Management in the Diabetic Foot. In: Shearman, C.P., Chong, P. (eds) Management of Diabetic Foot Complications. Springer, Cham. https://doi.org/10.1007/978-3-031-05832-5_14
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DOI: https://doi.org/10.1007/978-3-031-05832-5_14
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