1. DIABETES MELLITUS CORRECT FOOTWEAR FOR GRADE 1 FOOT PRESENTED BY KSRS.PRASAD

2. OUR INSPIRATION OBSERVATIONS IN VARIOUS MEDICAL TEXT BOOKS, JOURNALS AND FINALLY IN THE INTERNATIONAL CONSENSUS ON THE DIABETIC FOOT ST.VINCENT DECLARATION WHICH AIMS AT REDUCING AMPUTATIONS OF THE LOWER LIMB IN DIABETICS BY 50%

3. THERAPEUTIC/PROTECTIVE FOOTWEAR Therapeutic footwear is used to remove the mechanical load off the foot Total contact cast/orthoses may be used Protective footwear should include footwear for both indoor and outdoor use Protective footwear is based mainly on accommodation,cushioning and stabilisation Patients should know that wearing appropriate footwear is a life-long commitment and even short periods of wearing inappropriate footwear may result in an ulcer Ill-fitting shoes cause ulcers to the digits or the dorsum

4. HOW TO PREVENT FOOT PROBLEMS? REGULAR EXAMINATION OF THE “ AT RISK ” FOOT IDENTIFYING OF PATIENTS WITH “ AT RISK ” FEET SIMPLE AND REPETITIVE EDUCATION TARGETED AT HEALTHCARE PROVIDERS AND PATIENTS ADEQUATE PREVENTIVE FOOT-CARE IRRESPECTIVE OF SOCIO-ECONOMIC STATUS PERCOLATION OF KNOWLEDGE THAT THERE IS NO SUCH THING AS A TRIVIAL LESION OF THE DIABETIC FOOT MULTIDISCIPLINARY FOOT-CARE TEAMS

5. CORRECT DIABETIC FOOTWEAR CONSIDERATIONS THE SOLE THE INSOLE THE UPPER THE DESIGNS MAKING PRINCIPLES FITTING PROCEDURE FOOTWEAR CARE/ FOOTWEAR ORTHOTIC MODIFICATIONS

6. THE SOLE RIGID SOLE/ROCKER BOTTOM SOLE IN FORE FOOT ULCERS BROAD/LIGHT/TOUGH SOLE LOW HEEL/FLAT BOTTOM SOLE WITHOUT A SEPARATE HEEL SOLE WITH GOOD ANTI-SKID GRIP/ ROUNDED AT HEEL FOR EASY HEEL STRIKE/ RESPECTABLE WALKING ANGLE FOR TOE-OFF WITHOUT PRESSURE ON METATARSALS

7. THE SOLE CONT.. HEEL PITCH TO ACCOMMODATE PHYSIOLOGICAL FLEXION OF THE KNEE (PREVENTS HYPEREXTENTION OF KNEE AND PAIN OF HAMSTRINGS THEREOF). THE HEEL SHOULD ALSO SUPPORT THE ARCH THE SOLE IS NOT SOFT AND DOES NOT SINK UNDER THE BODY WEIGHT( A SOFT SOLE CAN CAUSE DORSIFLEXION OF THE FOOT CAUSING STRAIN ON HAMSTRINGS AND ENERGH LOSS)

8. THE SOLE CONT … NOT FLEXIBLE AND SO DOES NOT CAUSE TOE- BREAK OR HIGH PRESSURE ON THE METATARSALS THE SOLE SHOULD NOT BE THICK CAUSING EXCESSIVE GROUND CLEARENCE MAKING THE ANKLE VULNERABLE TO FRACTURES WE ARE WORKING ON A SPECIAL CONVERTABLE COMBINATION SOLE THAT SHOULD SERVE ALL THE NEEDS OF DIABETIC FOOT

9. OUR CRITICALLY IMPORTANT SPECIAL POLYMER INSOLE EXCELLENT COMPRESSIVE STRENGTH- Significantly higher than even PU foam/has a smooth surface and a soft feel EXCELLENT RESILENCE-Has excellent recovery after repeated flexing/compression VERY GOOD TENSILE AND TEAR STRENGTH- Remarkably tough/capable of taking repeated harsh treatment with little effect OUTSTANDING MOISTURE RESISTANCE- Closed cell structure/hydrophobic/water absorption and water vapour transmission rates are negligible

10. SPECIAL MCP INSOLE CONT.. CHEMICAL RESISTANCE- Has excellent chemical stability when exposed even to acids,paints,varnishes,thinners and alcohols THERMAL INSULATION-Excellent thermal insulator and is 35% better than any other soft foams SERVICE TEMPERATURE- Can be used in temperatures up to 70 degrees centigrade without significant effect on its properties BUOYANCY-Its low density,closed cell structure and water proof properties allow MCP to remain buoyant even when sliced or punctured

11. SPECIAL MCP INSOLE CONT … 15+2 Degree Shore A Insole as per Medically Accepted Standards. This softness minimises shock to the plantar surface and prevents sub-cutaneous hemorrhage. 8mm Thick to suit even heavy persons Establishes total contact with the foot on regular use thereby reduces Neutons( pressure) per unit area of the foot (ANASTOMOSIS). No Designs or Patterns on the Insole as these are found to affect the Plantar Pulp.

12. SPECIAL MCP INSOLE CONT … No Arch supports given as it is never possible to provide an accurate arch support to all( it is never uniform). A higher than necessary arch support causes inversion of the foot and leads to undue pressure on the lateral arch The insole establishes Total Contact and forms natural and correct arch supports The insole is not pasted in the shoes and can be conveniently replaced whenever called for We are working on many superior polymers, Total Contact insole techniques and materials

13. THE UPPER MATERIALS IDEALLY SOFT LEATHER SOFT POROMERIC MATERIALS THE LINING HAS TO BE LEATHER OR POROMERIC CLIMATIC CONDITIONS TO BE GIVEN ULTIMATE IMPORTANCE IN FINALISING UPPER/ LINING MATERIALS NON-WOVEN FABRIC LINED UPPERS IN SANDALS UNDER STUDY TO DEVELOP ECONOMIC FOOTWEAR

14. DESIGN-SANDALS ONLY BROAD STRAPS(NO NARROW STRAPS/NO WEBBING) NO TOE-RING/NO TOE-STEM FULL OR ADEQUATE HEEL COUNTER ADJUSTABLE UPPERS TO ACCOMMODATE OEDEMA NO THICK THREAD STICHING ESPECIALLY IN THE QUARTER

15. DESIGN-SANDALS CONT … CUT, PASTE AND LAST METHOD MOST IDEAL PROPORTIONATE AND ACCURATE WINDOWS AT THE 1 ST AND 5 TH METATARSALS MANDATORY NON-ADJUSTABLE UPPERS FOR THOSE NOT HAVING THE PROBLEM OF OEDEMA IS ACCEPTABLE MAXIMUM COVER OF THE FOOT MEANS MAXIMUM PROTECTION

16. DESIGN-SANDALS CONT … NO HARDWARE/ BUCKLES WITH THONGS ONLY VELCRO STRAPS AND SOFTER FORM OF VELCRO TO FACE THE SKIN EASY TO WEAR DESIGNS KEEPING THE AGE GROUP AND ACCOMPANYING MUSCULO- SKELETAL PROBLEMS IN VIEW DESIGNS FINALISED AFTER THOROUGH TRIALS ON GOOD NUMBER OF SUBJECTS ON A TWO- TIER BASIS

17. DESIGN-SHOES BROAD TOE RAISED TOE WIDE FITTING ACROSS THE FOOT MINIMUM STIFFENER AT TOE BOX/HEEL COUNTER ONLY DERBY MODELS WITH LACE/VELCRO FASTNERS(NO SLIP-ON MODELS) INSOLE NEVER PASTED-REPLACABLE

18. DESIGN-SHOES CONT … NO THICK THREAD STICHING IN THE QUARTER SOFT AND CONTINUOUS COLLAR MANDATORY PUNCHED HOLES FOR LACE AND NO ISLETS LACE WITHOUT METAL TIPS MODELS FINALISED AFTER PROPER TRIALS

19. MAKING PRINCIPLES EXTRA DEPTH SHOES UNIFORMLY THICK INSOLE AT BOTH HEEL AND TOE TO PREVENT EQUINUS SKILLFUL LASTING PROVIDES WALKING ANGLE NAILS/SHARP OBJECTS REMOVED INSIDE SHOES AFTER LASTING

20. MAKING PRINCIPLES CONT … SOFT SIDE OF VELCRO TO FACE THE SKIN NO THICK THREAD STICHING INSIDE THE SHOE NO METAL ISLETS/ METAL TIPS FOR LACE ENTIRE INSIDE OF THE SHOE TO BE FELT/ INSPECTED AND CLEARED AT THE TIME OF QUALITY CHECK

21. FITTING PROCEDURE FIT SHOES LATER IN THE DAY TAKE THE FOOT SIZE WHILE STANDING MEASURE BOTH FEET(PROVIDE MIS MATCH SERVICE OR FIT THE BIGGER FOOT SIZE AND PROVIDE INSOLE TO ELIMINATE PLY IN THE OTHER) FIT THE SHOE WITH THE BUYER WEARING REGULAR SOCKS ENSURE GOOD GAP BETWEEN TIP OF TOE AND TIP OF INSIDE OF SHOE

22. FITTING PROCEDURE CONT … CHECK THE FEET OF THE DIABETIC FOR POSSIBLE CHANGES DUE TO PRESSURE AFTER FIRST TWO HOURS OF USE ADVISE GRADUAL BREAKING INTO NEW SHOES ADVISE GOOD FOOTCARE REGIMEN ADVISE PERIODIC MEDICAL SUPERVISION

23. FOOTCARE ADVISE/ PRODUCTS PERIODIC FOOT INSPECTION PERIODIC MEDICAL CHECK PROPER SOCKS PROPER PEDICURE FOOTWEAR INSPECTION EVERYDAY MOISTURISING CREAMS/DUSTING POWDERS ETC., DEPENDING ON FOOT CONDITION REGULAR FOOT BATH IN WARM WATER WITH NON DETERGENT BASED ANTI MICROBIAL LOTION NEVER TO WALK BARE FEET

24. FOOTWEAR MODIFICATIONS ORTHOTIC MODIFICTIONS BY TRAINED EXPERTS META-TARSAL BAR MEDIAL/LATERAL WEDGE SPLINTS HEIGHT ADJUSTMENT NEVER ADVISE A DITCH TO BE MADE IN THE INSOLE AS IT CAUSES PRESSURE AT THE PERIPHERY OF THE ULCER( THE ATTEMPT SHOULD BE TO DISTRIBUTE PRESSURE/SHIFT PRESSURE)

25. OUR COMMITMENT OUR BACKGROUND IS THE INSPIRATION BEHIND OUR COMMITMENT CORRECT FOOTWEAR AT ITS BEST QUALITY AT EVERY STAGE OF MAKING-CHOICE OF MATERIALS TO MAKING OF THE PRODUCT NO COMPROMISE PHILOSOPHY EVEN FOR COMMERCIAL GAINS TOTAL FOOTCARE

26. THANK YOU YOURS IN FOOTCARE ALWAYS COMMITTED TO DIABETIC FOOTCARE