1. The Diabetic Foot: Relevance to Therapeutic Footwear Design

2. Diabetes is a condition where the body is unable to automatically regulate blood glucose levels, resulting in too much glucose (a sugar) in the blood Diabetes is a condition where the body is unable to automatically regulate blood glucose levels, resulting in too much glucose (a sugar) in the blood The blood glucose level is regulated with the help of insulin, a hormone (or chemical messenger) made in the pancreas. The blood glucose level is regulated with the help of insulin, a hormone (or chemical messenger) made in the pancreas. What is Diabetes?

3. Insulin is the key that glucose needs to enter the body’s cells so that it can be used as fuel. Insulin is the key that glucose needs to enter the body’s cells so that it can be used as fuel. Diabetes develops when the pancreas stops producing insulin (Type 1 diabetes) or when the body does not respond properly to insulin (Type 2 diabetes). Diabetes develops when the pancreas stops producing insulin (Type 1 diabetes) or when the body does not respond properly to insulin (Type 2 diabetes). What is Diabetes?

4. Initially insulin is still produced by the pancreas, but is less effective than normal. Initially insulin is still produced by the pancreas, but is less effective than normal. This is called insulin resistance and is an inherited characteristic made worse by obesity and a sedentary life style. This is called insulin resistance and is an inherited characteristic made worse by obesity and a sedentary life style. Type 2 Diabetes

5. Because insufficient insulin is available for glucose to move from the blood stream into the body cells and the liver, excess glucose remains in the blood stream resulting in higher than normal blood glucose levels (BGLs). Type 2 Diabetes

6. After years of poor eating habits and a sedentary life style, the pancreas may become “exhausted” and produce less insulin. After years of poor eating habits and a sedentary life style, the pancreas may become “exhausted” and produce less insulin. Early symptoms include thirst, tiredness and/or frequent urination. Early symptoms include thirst, tiredness and/or frequent urination. Without proper blood glucose control, diabetes can cause blurred vision, kidney disease, poor circulation, numbness, foot ulcers, and premature death. Without proper blood glucose control, diabetes can cause blurred vision, kidney disease, poor circulation, numbness, foot ulcers, and premature death. Type 2 Diabetes

7. Diabetes Continues to Rise

8. Key findings from the National Diabetes Statistics Report, 2014 (based on health data from 2012), include: 29 million people in the United States (9.3 percent) have diabetes. Majority are type 2 diabetics. 1.7 million people aged 20 years or older were newly diagnosed with diabetes in 2012. Non-Hispanic black, Hispanic, and American Indian/Alaska Native adults are about twice as likely to have diagnosed diabetes as non- Hispanic white adults. 208,000 people younger than 20 years have been diagnosed with diabetes (type 1 or type 2). 86 million adults aged 20 years and older have prediabetes.

9. Diabetic foot ulcers are sores on the feet that occur in 20% of diabetic patients some time during their lifetime. Diabetic foot ulcers are sores on the feet that occur in 20% of diabetic patients some time during their lifetime. The risk of lower-extremity amputation is increased 8-fold in these patients once an ulcer develops. The risk of lower-extremity amputation is increased 8-fold in these patients once an ulcer develops. Diabetic Foot Ulcers

10. Diabetic foot ulcers are caused by neuropathic (nerve) and vascular (blood vessel) complications of the disease. Diabetic foot ulcers are caused by neuropathic (nerve) and vascular (blood vessel) complications of the disease. Nerve damage due to diabetes causes altered or complete loss of feeling in the foot and/or leg. This is known as peripheral neuropathy. Pressure from shoes, boney deformity, or any injury to the foot may go unnoticed. Nerve damage due to diabetes causes altered or complete loss of feeling in the foot and/or leg. This is known as peripheral neuropathy. Pressure from shoes, boney deformity, or any injury to the foot may go unnoticed. The loss of protective sensation stops the patient from being warned that the skin is being injured and may result in skin loss, blisters and ulcers. The loss of protective sensation stops the patient from being warned that the skin is being injured and may result in skin loss, blisters and ulcers. Diabetic Foot Ulcers

11. Ulcers untreated can lead to the amputation cycle with eventual loss of the limb. Ulcers untreated can lead to the amputation cycle with eventual loss of the limb. Statistics show a very high morbidity for these individuals once this happens. Statistics show a very high morbidity for these individuals once this happens. So... a diabetic ulcer on the foot is a high risk for loss of life and thus must be prevented. So... a diabetic ulcer on the foot is a high risk for loss of life and thus must be prevented. Diabetic Foot Ulcers

12. Diabetes causes slow wound healing Prevention of ulcers is key

13. Inadequate footwear independently tripled amputation risk. Inadequate footwear independently tripled amputation risk. Education of professionals and patients, particularly about footwear and foot care, coupled with improved diabetes clinical care, is key to reducing amputation risk Education of professionals and patients, particularly about footwear and foot care, coupled with improved diabetes clinical care, is key to reducing amputation risk Therapeutic Footwear saves lives

14. EXERCISE IS MEDICINE Obesity and a sedentary lifestyle are high risk factors in diabetes Obesity and a sedentary lifestyle are high risk factors in diabetes EXERCISE IS MEDICINE.. As simple as walking.. But wearing the correctly fitted therapeutic shoe is imperative EXERCISE IS MEDICINE.. As simple as walking.. But wearing the correctly fitted therapeutic shoe is imperative

15. Therapeutic Footwear Features Closure systems: To protect from pressure on the dorsum of the foot. Padded tongues secured by lace, Velcro straps and tie-less lace. Closure systems: To protect from pressure on the dorsum of the foot. Padded tongues secured by lace, Velcro straps and tie-less lace. Ventilation: Mesh and/or leather uppers to enhance airflow. Midsole: Foam material that provides excellent cushioning to reduce pressure on the balls of the feet. Outsole: Must offer grip to prevent falls. Rubber is excellent. Stability: Important to reduce the stress on the ligaments and tendons in those that over or under-pronate. Weight: A lighter shoe causes less energy used.

16. BEST STABILITY SHOES All our PDAC approved New Balance and Brook’s shoes offer technological design features designed to control excessive rearfoot and midfoot motion. All our PDAC approved New Balance and Brook’s shoes offer technological design features designed to control excessive rearfoot and midfoot motion. Stabilizing the diabetic foot reduces stress while slowing the progression of joint subluxation and subsequent high pressure areas. Stabilizing the diabetic foot reduces stress while slowing the progression of joint subluxation and subsequent high pressure areas. The NB 813 is our most popular walking shoe and features a rollbar on both sides of the heel for enhanced stability. The NB 813 is our most popular walking shoe and features a rollbar on both sides of the heel for enhanced stability.

17. Best Extra-Depth Shoes Our Nature’s Stride and Orthofeet shoes are excellent choices when extra room is needed. Our Nature’s Stride and Orthofeet shoes are excellent choices when extra room is needed. For the high risk diabetic foot with foot deformities or swelling. For the high risk diabetic foot with foot deformities or swelling. Ideal for toe-fills and custom diabetic inserts for off-loading to prevent ulceration. Ideal for toe-fills and custom diabetic inserts for off-loading to prevent ulceration.

18. Best Shoes for PTTD Diabetics are prone to developing Posterior Tibial Tendon Dysfunction. Diabetics are prone to developing Posterior Tibial Tendon Dysfunction. Boots provide higher support up the ankle to lessen the stress on a weak or strained Posterior Tibial Tendon. Great for people that do not want to wear an AFO. Boots provide higher support up the ankle to lessen the stress on a weak or strained Posterior Tibial Tendon. Great for people that do not want to wear an AFO. Dia-Foot carries a number of boots in our catalog to choose from. Dia-Foot carries a number of boots in our catalog to choose from. Wolverine Harrison Boot

19. For severe swelling/Deformities For severe swelling/Deformities Our elastic spandex Orthofeet shoes stretches and conforms to the foot. Our elastic spandex Orthofeet shoes stretches and conforms to the foot. Eases pressure on foot deformities causing great protection for the diabetic foot. Eases pressure on foot deformities causing great protection for the diabetic foot.

20. Always Assist your Patient with Choosing the Right Shoe Your patient may select a boat shoe but if your patient has severe foot deformities, then that would provide a poor fit. Your patient may select a boat shoe but if your patient has severe foot deformities, then that would provide a poor fit. knowledge of the shoes will help you have more success in helping your patient pick the right shoe. knowledge of the shoes will help you have more success in helping your patient pick the right shoe.