Orthotic Solutions for Complications

develop in foot related to Diabetic

Apeksha(Endolite Lanka)

What is an Orthosis?

An Orthosis is a device which is fitted to the outside of the body to support a weakness, correct a deformity, prevent a deformity/contracture, promote healing, direct growth, enhance function with better positioning, maintain joint stability, decrease pain and/or inflammation, and/or to rest and support weakened structures.

Lower limb Orthosis

FO- foot Orthosis

Lower limb Orthosis

AFO- Ankle Foot Orthosis

Lower limb Orthosis

KAFO- Knee ankle Foot Orthosis

Stages of Diabetic foot

Callus

Inflammation Ulcer Infectio

nAbsces

s

GangreneAmputation

Complication related to DiabeticCallus One of the body’s first reactions to pressure is to create a callus. A

Callus is made up of dead skin cells that are piled up on one another and form a hard layer. The role of the callus is to protect the skin underneath. But when calluses get thick in weight bearing areas, they actually put additional pressure on the skin underneath.

How to deal with a callus

1. Medial arch support to increase the area of weight bearing and reduce pressure ,

2. Dome or Bar Support to reduce pressure from MT heads And to reduce Clow toes as well

3. Use, well fitting extra Depth shoe to insert a FO

Ulcer After the WBC have removed the damaged tissues they should be

replaced with new tissue, but the patient keeps walking, keeps applying forces and the tissue keeps getting damaged. This leads to a “hole” forming in the skin, an open sore we call an ulcer.

1. Ulcer can be treated with FO in early stage.2. If the infection happen and when its in a condition of abscess .its

usually need to reduce the motions over ankle and mid foot , so the inflammation will be reduce, FO will be not enough to do that. then we go for AFO

3. If fore foot ulcer its use Rigid AFO, and IF heel ulcer need to use PTBAFO.

4. With a Rigid AFO and PTB AFO we may need to do shoe modification to get easy roll over at 3rd rocker.

Charcot foot / Charcot Joint / Charcot Arthropathy / Rocker bottom foot.   Injury to an insensate foot (ulcer, sprain, micro fracture) Inflammation and increased blood flow to the area Increased blood flow leads to reabsorption of minerals from the bones, making them

weak. Weakened bones fracture under “normal” stresses.  This cycle then feeds itself and the rate of deformity can accelerate. As deformity

increases, abnormal forces are generated on the structures of the foot, again leading to further damage. 

It is common to see a plantar ulcer on the mid-foot of the Charcot foot, as the foot takes up a convex shape forces are focused on the boney midfoot area.

Rigid AFO PTBAFO Offload the foot and promote

heeling of the ulcers Protect the Foot Structure Immobilize the foot so it helps

to reduce the inflammation. Unlike Total contact cast patient

can remove when not walking. patient can still walk so blood

circulation also encourage.

Total contact casting is normally used .but, Same function can be achieved with PTB AFO and Rigid AFO

Offload only the fore foot and promote heeling of the ulcers

Protect the Foot Structure

Immobilize the foot so it helps to reduce the inflammation. Unlike Total contact cast patient can remove when not walking.

patient can still walk so blood circulation also encourage.

Amputation When an infection / abscess / gangrene can not be treated the

affected tissues must be removed surgically, otherwise the death of tissues can lead to septicemia (poisoning of the blood) or a “chain reaction” of tissue death.

How to Make a Orthosis1. Do the Subjective assessment of patient( Age, Occupation , Family background)2. Do objective assessments (Mussel Strength, Range of motion of the Joints, Gait

analysis in Sagittal and Coronal planes.3. Make Orthotic Objective with the assessment and Prescribe the suitable device 4. Take a Cast of the limb 5. Fill the Negative cast and get a Positive cast, and do the rectification of the

cast.6. Do the Fabrication.7. Dot the Fitting of the Device with patients8. Adjust the device with Dynamic and Static and get the out come as in orthotic

Goals 9. Deliver the device with proper device caring details.10. Have follow up with patients…….

Thank you!