Orthopedic appliances
Inlays
Shoes
Orthoses
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Inlays pressure distribution and pressure relief
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Special shoes of the shelf
combined with inlays
shoes with a rigid outsole, no seams on the inside
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Orthopedic shoes
NOF, Norsk Ortopedisk Fotty
as Custom made shoes
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Silicone Foot-Toe orthoses
Offloading and/or correction of toes
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TAFO:
Total offloading Ankle Foot Orthosis
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A foot with a
neuropathic foot
ulcer or a
Charcotfoot
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Treatment is empirical and relies on
rest and strict limitation of weight
bearing, usually with total contact
casting. Removable casts and
walkers have also been
recommended
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It appears that a total contact cast (TCC) heals a higher
proportion of neuropathic plantar ulcers at a faster rate
than removable modalities such as a removable walker
(RW), off-loading shoes (i.e. half-shoes) and therapeutic
footwear (evidence: 1-, 1-, 1-, 2-).
It appears that a RW which is made non-removable is more
effective than a RW and similarly effective as a TCC in
healing diabetic neuropathic plantar foot ulcers (evidence:
1+, 1+, 1-).
A preponderance of evidence in the area suggests that a
dedicated focus on adequate pressure relief is an
important and likely essential component of successful,
consistent and predictable healing for the majority of
neuropathic diabetic foot wounds. Because of its effect on
pressure reduction and adherence to therapy, we
recommend consideration of the use of a TCC in treatment
of neuropathic, non-infected, non-ischemic plantar diabetic
foot ulcers.
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A number of studies in healthy people have shown that
making the outsole rigid and either "rockered" or "rollered"
can be extremely effective in reducing plantar pressure in
the forefoot 118,119. While similar results have been
observed clinically in diabetic patients, definitive studies in
this patient group are required before recommendations for
their use can be made.
Rocker shoe: Shoe with rigid outsole designed with a sharp
transition on the outsole. The shoe rocks forward in the late
support phase to allow walking without extension of the
metatarsophalangeal joints.
Roller shoe: Shoe with rigid outsole similar to the rocker
shoe, but with a contoured outsole to provide a smother
transition during walking.
van Schie C, Ulbrecht JS, Becker MB, Cavanagh PR: Design criteria for rigid rocker
shoes. Foot Ankle Int 2000; 21: 833-44
Nawoczenski DA, Birke JA, Coleman WC: Effect of rocker sole design on plantar
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forefoot pressures. J Am Podiatr Med Assoc 1988; 78: 455-460
Plaster cast
Plaster negative
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Plaster positive
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Rectification: ulcer pressure relief +
toebox
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Construction of orthosis
Ulcer
Sandwich constructed
insole
multiform soft, easy
to mould, smooth and
easy to clean
Ppt soft and pressure
relieving
Microcork firm,
supports
Charcot
Insole material 40
shore
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Soft material on the
inside of the orthosis
Moulded in
polypropylene first
the orthosis then the
lid
Choice of
colour/pattern
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Outsole made of
EVA
Roller outsole
The apex of the
roller sole behind
the ulcer
Rubber outer sole
Velcro straps
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Function
Compression
Ulcer
Mecanical offloading and
redistribution of pressure
Some of the load is transferred to the
calf
Charcot
Prevent deformities
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Alternative to TCC
The pasient can take the
orthosis off at night
Better hygiene
Can put weight on the
foot and be moderately
active
Can walk with the orthosis
outside, summer and
winter
Compliance never put
weight on the foot without
wearing the orthosis
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Other AFOs
Neuropathy can lead
to poor balance
Of the shelf orthoses
Light weight
Easier to put on and
take off and easier
to walk
Always made with a
made to measure
inlay
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