Management of the Diabetic Foot: Preventing Amputation

Marvin E. Levin, MD

Disclosures

South Med J. 2002;95(1) 

In This Article

Therapeutic Shoes

The use of therapeutic shoes is critical in preventing ulceration or recurrence. Patients who have cocked-up toes require a shoe with a bigger toe box. In addition, an in-depth shoe with an insole of a plastic-like material is frequently required to redistribute the weight away from the previously ulcerated site and thus prevent recurrence. The patient with a marked deformity, such as Charcot's foot, needs a molded shoe.

The importance of wearing therapeutic shoes has been clearly shown. A study at King's College[57] in London showed that while patients who wore therapeutic shoes had an ulcer recurrence rate of only 17%, those who returned to wearing regular shoes had an 83% recurrence rate.

Exercises for Diabetics With Peripheral Neuropathy
  • Non-weight-bearing exercise

  • Swimming

  • Chair exercise

  • Cycling

  • Rowing

A recent demonstration study[58] that supplied therapeutic shoes to diabetic patients with selected foot problems showed no increased cost to Medicare. Medicare now provides partial payment for therapeutic shoes for diabetic patients with specific foot problems. For proper fit of therapeutic shoes and selection of appropriate insoles, a podiatrist and/ or certified pedorthist should be consulted.[59,60]

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