Comfort Shoe Specialists
11693
Manchester Rd
St. Louis, MO 63131
314-822-3300
"These Shoes Are Killing
Me"
By Edith James, C. Ped.
| Full or partial foot amputations used
to be a common hazard for patients struggling with diabetes. Loss of
feeling led many diabetics to wear tight footwear so they could
"feel" their feet. Unfortunately, that practice often hurt
more than it helped. Stress fractures and foot deformities, like bunions
and hammer toes, were more likely to occur. In addition, the tight
footwear made already poor circulation in the feet even worse. Lack of
feeling, caused by neuropathy, helped serious foot problems escape notice
until full or partial foot amputation was the only alternative. The
phrase, "These shoes are killing me," was no joke. |
Edith James, C. Ped.
|
Today's story is much brighter. Believe it or not, good
foot care and properly fitted shoes may be the biggest defense for problems
ranging from ulcers to Charcot foot. To fight diabetic foot problems, physicians
should solicit help from a board-certified pedorthist. Pedorthists are the
footwear-fitting experts of the diabetic care team. They perform foot screenings
for neuropathic and diabetic patients and dispense shoes that are scientifically
fit. They also educate patients about footwear, sock selection, general foot
health, and instruct them on inspecting feet and shoes.
In practice, here's how it works: Pedorthists perform the
Carville Diabetic Foot Screen on diabetic and neuropathic patients. Usually a
family member is present while the pedorthists tests sensation at 10 sites,
while the patient sits with his/her eyes closed. In addition, nails, skin,
shape, weakness in the foot and ankle are examined and evaluated. Many times the
family is surprised by the lack of sensation in their loved ones. Often this
experience helps family members become more supportive care givers.
Diabetic Foot Screen
| Risk Categories |
Management Categories |
Risk Category 0
Has a disease that leads to
insensitivity
Has protective sensation
Has not had a plantar ulcer |
Management Category 0
Examine feet at each visit or at
least 4x a year
Foot Clinic once a year
Patient Education |
Risk Category 1
Does not have protective sensation
Has not had a plantar ulcer
Does not have a foot deformity |
Management Category 1
Examine feet at each visit or at
least 4x a year
Foot Clinic visit every 6 months
Soft Insoles of plastazote, PPT, ect.
Patient Education |
Risk Category 2
Does not have protective sensation
Has not had a plantar ulcer
Does have a foot deformity |
Management Category 2
Examine feet at each visit or at
least 4x a year
Foot Clinic visit every 3-4 months
Custom molded insoles
Prescription Footwear
Patient Education |
Risk Category 3
Does not have protective sensation
Has a history of plantar ulcer |
Management Category 3
Examine feet at each visit or at
least 4x a year
Foot Clinic visit every 1-2 months
Custom molded insoles
Prescription Footwear
Patient Education |
Below is an example of the form we use to
screen the diabetic foot.
Click to see form
The most likely location of an ulcer is the hallux, the
second most likely location is the first metatarsalphalangeal joint (mpj), and
the third is the fifth mpj with the other mpjs following. Almost all
non-traumatic ulcers are caused from thousands of micro traumas that first
manifest as callouses. An astute examiner realizes that a callous is a warning
sign that should be addressed with trimmings and proper footwear. If the callous
continues, an orthoses should be prescribed to improve the biomechanics that are
causing the shearing and pressure. Every callous should be regarded as a warning
sign that current footwear is lacking in support, cushioning or both.
With serious joint breakdown, such as Charcot foot, the
pedorthist's job is to protect bony prominences by reducing pressures and
providing stabilization for the deformity. Today, there are manufactured wide
shank, in-depth footwear that many Charcot feet fit in nicely with accommodative
orthoses. Custom shoes are still available for grotesque deformities. High-top
shoes may be recommended in the category 3 patients because sensation tends to
increase up the leg so that proprioception for the patient is also increased.
Balance improves with increased proprioception.
As a part of the diabetic foot team, the pedorthist can
provide specialized knowledge about appropriate and/or prescription footwear.
With proper evaluation, education and follow-ups, diabetic patents may never
again have to say, "These shoes are killing me."
Edith James, C. Ped. is President of Comfort Shoe
Specialists, Inc.
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