Lower Extremity Review
Welcome to the first mini publication on diabetic foot care. LER has created an easy to read, practical real world approach to diabetic foot care designed to improve outcomes for your diabetic patients. Articles on diabetic footwear, diabetic socks, compression hosiery, diabetic insoles and the Therapeutic Shoe Bill offer in depth information to assist in your daily practice.
We hear a lot about evidence-based medicine these days. And there are certainly a number of benefits to being able to base treatment decisions on data from high-level published studies. But practitioners who treat diabetic patients know all too well that healthcare in the real world is different from healthcare in the literature.
Jordana Bieze Foster, Editor
Socks are often an afterthought for patients with diabetes, but they shouldn’t be. Advances in materials science and new twists on old favorites mean that modern socks conform to feet without the bunching, chafing, slipping, and irritation of the past. Some even promote healing.
By Shalmali Pal
Diabetic feet need pampering and protection from microtrauma, but they also need stability and support. A diabetic insole, representing the ultimate middle ground between sock and shoe, should offer the best of all worlds: cushioning, structure, shock absorption, and durability.
By Shalmali Pal
Proper selection and sizing of compression hosiery can be confusing, but both are essential for control of edema and management of more serious vascular conditions in patients with diabetes. And then there’s the even more challenging issue of patient compliance.
By Shalmali Pal
Taking full advantage of the TSB means jumping through more than a few bureaucratic hoops, as mandated by the federal government. But it also requires that lower extremity experts build better working relationships with each other and with their diabetic patients.
By Shalmali Pal
As important as it is to fit the foot properly within the shoe, that’s only one part of the process. Patients’ comorbidities, personality, and fashion sense all determine the extent to which a pair of footwear can maximize a diabetic patient’s outcomes and minimize complications.
By Shalmali Pal
We published 12 information-packed issues,and readers responded— on our website and through our social media outlets. These are just a few of the highlights.
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AFOs must find energy balance – The extent to which carbon composite ankle foot orthoses improve gait efficiency in stroke patients may be a function of walking speed, according to a Swedish study. And despite the fact that the devices are known for their energy storage, research from the Netherlands suggests that the relationship between energy storage and energy cost may be complicated.
Is earlier intervention needed? Researchers and clinicians are only beginning to understand the relationship between pediatric flexible flatfoot and obesity, which becomes even more complicated in the context of orthotic treatment. Findings from Hong Kong appear to throw another wrinkle into the mix, suggesting that obese children are significantly slower to respond to orthotic therapy than their normal-weight counterparts.
Biomechanics may offer clues – Too often, by the time Charcot neuroarthropathy is diagnosed, it is too late to do much more than accommodate the resulting deformity. That’s why researchers from Germany and the U.K. are working to find ways of screening for patients at risk for Charcot, which would facilitate earlier and more effective intervention.
But placebo findings raise questions – Three German studies presented at the ISPO meeting in Leipzig confirm that bracing for knee osteoarthritis is associated with both symptom improvement and biomechanical effects. But the findings also suggest that the relationship between those two sets of outcome measures is more complicated than one might think.
Fancy camera systems not required – A pressure measurement system is an essential clinical tool for maximizing orthotic outcomes that too many practitioners are not yet utilizing, according to two presentations at the FIP meeting in Amsterdam.
Top opinion leaders and researchers from across the globe came together in May for the International Society of Prosthetics & Orthotics (ISPO) meeting in Leipzig, Germany, and the International Federation of Podiatrists (FIP) meeting in Amsterdam. This special report covers a range of topics from both events, specifically selected for their relevance to the lower extremity practitioner. By Jordana Bieze Foster
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