Answers to: FO's for diabetics

Answers to: FO's for diabetics

1 plus 1 orthotics

6/5/2001

Dear List

Thanks to all that have answered - here are some of the answers;

This was the question:

I have been makinf FO's for diabetics for a while now, but I am curious to know what other peoples experince is -

What have you found to be the best way ( if such a thing exists ) to take an impression for an FO for a diabetic patient, - weight-bearing, partial weight-bearing or non weight-bearing .?

What considerations are at play ?

your experience and advice would be most welcome

with thanks

Vivian Alexander CO
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Hi Vivian...Jane Marlor here...I take all my FO impressions with a Foam
Block...the only pts I use plaster with are the Rheumatoids that I can move
or change position on...Take the impression non weight bearing
ie...DONT let them PUSH into the foam... have the pt sit at 90-90... 90 at
the hips and 90 at the knees grasp the midfoot in a supinated
position...slightly externally rotate the hip as you place the foot into the
foam...push down on the knee and internally rotate the hip to neutral while
holding the foot with the other hand...thumb usually is at the arch...THEN
while stabilizing the knee take the hand that was in the arch to the
forefoot and depress the toes into the foam. The Key here is you DON'T allow
the pt to push or help...I only let them help pick up their foot out of the
impression.The foam impression will yield any divots for pressure
relief...or you can mark the foot/dressing with lipstick for
reference...BEFORE you fill the impression...take and flatten out the toe
region this eliminates the need to fill in with plaster...I usually extend
the toe region slightly then make my FOs fit the shoe not the foot in
length...this slows down the shear forces and motion in the shoe...Good
Luck... should you need any help I am available to teach techniques,
modifications, and fabrication...Jane E. Marlor, CO(L), LPed, FAAOP.

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If you haven't been to a Bottom Block seminar with Dr. Edward Glaser then you should
make a point to go as soon as you can. He uses a specific and reproducable technique
that works very well for almost all patient's including the diabetic. He is based out
of Bon Aqua, Tennesse. He has an excellent product called Sole Supports. I have been
using them for about a year now and have had extremely good luck with them. I'm sorry
that I can't describe it in an email, but it is very specific and would be very hard
to explain. Good luck in your search.
Kelly Clark CO
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I simply push the pt's foot into a foamart or similar while attempting to
keep the forefoot parallel to the hindfoot (not rocket science, just
estimate based on your initial foot evaluation). Assess the impression.
If the alignment is visually off, reinsert the pt's foot and push down on
the area of the foot where it is necessary to correct the
impression.(once again, not rocket science). The reason I do the
impression this way is so the natural arches are maintained and will
provide adequate support when wt. bearing occurs. The bottom line is,
the insert is going to be made of a soft or semi-soft material, given the
pt. is diabetic. Once the insert is made, there is all sorts of
flexibility and give & take that getting too technical about taking the
impression is just not necessary (in my humble opinion). Exception: if
you are attempting to unweigh a specific area, i.e. ulcer, heavy callous,
you obviously need to pay more attention.
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Vivian, where possible, that is, when I can get the aptient to stand, I take
a weight bearing cast because I believe that this gives me a more accurate
representation of their situation. The complex part is when it comes to
correction: I have to manually correct when they are standing or afterwards
when I am cast modifying.
Weight bearing casts allow for the foot-spread caused by their weight and
give a flat heel tissue profile that would be present normally in standing.
Richard Ziegeler
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I have worked on this question of best way to cast for Total Contact inlay
construction for thirty years. I have concluded that our best results come
from Wax and Sand Casting. However we have changed from using regular sand
to using the microcellular glass beads that are used for sand blasting. They
are of a uniform size and they flow like water when compressed until the
pressure on them is totally uniform so that in the casting process you get
uniform compression of soft tissue against the skeleton structure. Then the
inlays made on the foot forms made in this process likewise give uniform
compression of soft tissue, spreading the weight bearing out over as wide an
area as possible. The exception to this is when you have an ulcer site that
has been caused by ischemia. Then you want to create an area of lessor
pressure under this area, and a higher pressure area directly behind it by
postings. This forces blood into the ischemic area with each step the
patient takes. This Oxygenates the ischemic area and nourishes, it speeding
the healing of the ulcer site. There is an essay on our web site that is
copyrighted, It is called, The Theory. You may enjoy reading it, at
footcomfortworld.com
Carl Riecken
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I prefer to cast the leg, then use a block of foam rubber about 3 inches thick under the foot as I support the foot to bring the ankle to 90 degrees, only using the weight of the leg. This preserves the shape of the foot to help keep an even pressure on the bottom of the foot in the orthosis. I instruct the cast tech NOT to flatten the bottom of the cast.
Rough sketch but hope it clarifies my answer.
Don
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