1. Ideal Footwear for diabetics Presented by, Dr.J.L.Shah Physician & diabetologist Sonal Hospital & diabetes clinic, Lalgate, Khandbazar, Surat.

3. Risk for foot ulcer Grade 0: Protective sensation present Grade 1: Loss of protective sensation Grade 2: Loss of protective sensation and deformity Grade 3: History of foot ulcer + PAD + neuropathy

4. Footwear for grade 0 foot Normal athlete shoes for most patients Should be proper in size.1/3 to 1/2 inch longer than the length of the foot. The widest part of the footwear should correspond to the first MT head. Should be properly styled avoiding narrow toe box and high heel. Avoid using hard materials. Annual visit, foot checkup and routine foot care education recommended.

5. Footwear for grade 1 foot These pts. Have 20-30% higher risk for foot ulcer compared to grade 0 pts. These pts.require more frequent visit to diabetes foot care clinic (twice in a year) and education on trauma prevention. To protect insensate foot specially designed footwear/insoles are recommended. Such footwear are effective in reducing ulcer incidents in these pts.

6. Footwear for grade 1 foot cont.. Ideal Consideration: The sole The insole The upper The designs Making principles Fitting procedure Quality standard with regard to materials used

7. Footwear for grade 1 foot cont.. The sole: Rigid/light/broad Low heel/flat bottom Rounded at heel with good anti-skid grip Thickness should be from 8 to 15 mm. Should be tested for its hardness and flexibility and abrasion resistance.

8. Footwear for grade 1 foot cont.. The insole: No material can replace human body’s soft tissue properties. Cushioning effect to protect planter surface of foot from vertical and sheer stress during walking. 15 to 20 shore-A hardness is recommended. 8 to 10mm thickness insole from single material or multilayered insole from different materials. PU-EVA or MCR insoles are available and useful.

9. Footwear for grade 1 foot cont.. The upper materials: Ideally soft leather, soft poromeric material Should be roomy to accommodate forefoot. Designs & making principle (shoes and sandals): Wide and roomy toe-box,replacable insole, low heel, extra depth, velcro/lace fastening, no metal eyes or buckles, no thick thread stitching inside =for shoes. Wide velcro adjustable straps for cover to accommodate oedema- adequate heel counter or 2cm heel strap, no thick thread stitch and replaceable insole =for sandals

10. Fitting procedure New shoe should be fitted in the evening in standing posture with socks worn. Patient “feel” with neuropathy should not be relied With different company with same number, the size of the footwear is variable New footwear initially should be worn in house for short period only and signs of extra pressure should be inspected after its use and broken gradually by slowly increasing wearing time

11. Footwear for grade 2 & 3 foot Most deformities like claw toes can accommodated in extra depth shoes Customized footwear in needed for severe deformities Foot impression taken using impression boxes and negative last prepared from it is useful in making such footwear Cradle- insole useful for severe neuroischemic foot.

12. Ulcer due to tight shoes Custom made footwear to accommodate Bunion deformity