Best orthotic materials for diabetics
Foot orthoses designed to prevent ulceration in the diabetic patient should act to reduce those forces that lead to ulceration, namely pressure and shear.
Preventing foot ulceration is a critical aspect of the overall treatment of diabetic patients. Ulcer prevention includes patient education, regular screening, use of proper shoes and socks, palliative care as needed and the use of orthotic devices specifically designed to reduce those forces that are likely to lead to ulceration.
Given the propensity for decreased natural cushioning in diabetics and the strong relationship between decreased fat pad and increased pressure, it is beneficial to include soft-tissue supplements in the form of cushioning materials when prescribing orthoses for diabetic patients. These soft tissue supplements should be included as part of a topcover on an orthotic device. There are many materials available and these include foams, rubbers, and viscoelastic materials. Although there is limited data indicating which of the cushioning materials are the best replacement for the natural cushioning provided by the fat pads, there is some evidence to help us determine the materials that are likely to be most effective. Paton, et al. investigated the physical properties of materials used to fabricate orthoses designed for the prevention of neuropathic diabetic foot ulcers. They found that the most clinically desirable dampening material was Poron® . 19 Campbell, et al. found Poron® to have a significantly longer effective life when compared to other soft tissue supplement materials.
Orthotic Prescription Recommendation:
• Topcover: A topcover with soft tissue supplement should be included on all orthoses for diabetic patients. Although the study by Tong and Ng showed the greatest reduction in plantar pressure with the use of Poron® and firm Plastazote® , firm Plastazote® is a difficult material to conform to an orthosis when producing a topcover, so for the time being, this author would recommend using Poron® alone for cushioning. Poron® , however, has a tendency to tear in response to shear forces, so it must be glued to a top layer of a material that is not prone to tearing. The current topcover recommendation is for 3mm or 4.5mm Poron® glued to a top layer of leather or 1.5mm soft EVA, either of which will prevent tearing of the Poron®
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