Footwear For Every Diabetic Training Manual for Therapeutic Footwear Prepared By Bent R. Nielsen, Gentofte University Hospital, Denmark & The Footwear Team Baqai Institute Of Diabetology & Endicrinology Baqai Medical University 1 Karachi - Pakistan Compiled by: Mr. Bent R. Neilsen Chief Podiatrist – Gentofte University, Hospital, Denmark Prof. Abdul Basit Director – Baqai Institute of Diabetology and Endocrinology Chair Elect – IDF Middle East and North Africa Dr. Zahid Miyan Consultant Diabetologist – Baqai Institute of Diabetology and Endocrinology Assistant Professor - Baqai Medical University Project Director – Footwear for Every Diabetic Dr. Asmat Nawaz Consultant Diabetologist – Baqai Institute of Diabetology and Endocrinology Project Manager: Footwear for Every Diabetic Dr. Riaz Ahmed Memon Footwear Section: Diabetic Foot Department, Baqai Institute of Diabetology and Endocrinology Project Coordinator: FED Project Mr. Sufran Ahmed Project Assistant: FED Project 2 Contents Section-A: ……………………………………………………………………………………………………………………………….….... 1010 Diabetes and its Complication, Foot problem in people with Diabetes: .....................................1 100 Complications of Diabetes: ..........................................................................................................11 11 Diabetic foot .................................................................................................................................12 12 Ulcer ..............................................................................................................................................12 12 Diabetic foot ulcers (DFU) .............................................................................................................12 12 Neuropathy ...................................................................................................................................12 12 Peripheral Arterial Disease ......................................................................................................... 16133 Anatomy of foot & ankle …………………………………………………………..…………………..…………………....1313 Basic Foot Anatomy ……………………………………………………….………………………………………..…………..1414 Basic Ankle Anatomy ....................................................................................................................14 14 Biomechanics of the Foot ………………………....………………………………………………….……………….……..1515 Gait and Gait Cycle .............................................................................................................…... 1515 Foot Deformities …………………………………….......................................................... ..................... …1616 3 Hammer toe: ............................................................................................................................... 16166 Claw toe: ...........................................................................................................................................17 Flat feet / fallen arches: ................................................................................................................17 17 High Arched Feet ...........................................................................................................................17 17 Metatarsalgia ................................................................................................................................18 18 Bunion Foot ...................................................................................................................................18 18 Charcot Foot ..................................................................................................................................18 18 Risks Assessment & Recommendation Of Footwear ....................................................................19 19 Knowledge & Importance of Footwear ........................................................................................20 20 Routine wearing of appropriate footwear for people with diabetes ....................................... 22119 Appropriate footwear ................................................................................................................. 21222 Footwear wearing instruction with Break-In period …………………………………………………...…….…2233 When to replace or repair shoes ………………………………………………….…………………………………….…2233 Section-B…………………………………………………………………………………………………………………………..24 Equipments and tools ...................................................................................................................24 24 Stitching Machine ………………………………………………………………………………..……………………………..…2255 4 Flatbed Stitching Machine …………………………………………………………………………………………. ..…... 25 25 Post Bed Stitching Machine ………………………………………….…………………………………………………….. 25 25 Grinding Machine: ………………………………………………………………………………………………….…………......2626 Oven ..............................................................................................................................................26 26 Heating Blower: ............................................................................................................................27 27 Measuring Instrument & Tools: ....................................................................................................27 27 Safety instruments: .......................................................................................................................27 27 Materials & Characteristics of materials required ........................................................................28 28 List of Materials: ...........................................................................................................................29 29 Grinding techniques: …………………………………………………………………………………………………………….…3030 How to take the measurement of the foot ................................................................................ 30311 To measurement length: ………………………………………………...………………………………………………………3311 Measurement width: ……………………………………………………………………………………………………………...3232 To measurement Instep: …………………………………………………………………………………………………….…..3233 TIPS For Marking on Sketch for different deformities……………………………………………………………...3333 5 Forefoot support: ………………………………………………………………………………………………………………....3333 Medial support (S-Shaped): …………………………………………………………………………………………………..3344 Lateral support: …………………………………………………………………………………………………….……….……...3344 Medial Movement stopper: ………………………………………………………………..…………………………….....3434 49 Finger test to examine Foot Arches: ………………………………………………………………………………….....3535 Normal Arch feet: ……………………………………………………………………………..………………………… ...... ..35 35 Low Arched feet (pes planus): …………………………………………………………………………………………......3535 High Arch feet (pes Cavus): ………………………………..…………………………………………………………........35.35 Manufacturing of footwear for people with diabetes according to IWGDFriskcategories:…36 36 Method of cutting the pattern: ………………………………………………………………………………………….…37.3 7 Method for making the upper part:………………………………………………..…………………………..….…. 3838 Manufacturing of footwear for risk category 0 ............................................................................39 39 Steps of Footwear Manufacturing .............................................................................................39 39 6 The outer sole of the footwear .....................................................................................................39 39 Insole .............................................................................................................................................40 40 Top cover on Insole .......................................................................................................................40 40 Upper part of the footwear ........................................................................................................ 42411 Lasting & Finishing: .................................................................................................................... 42411 Manufacturing of footwear for risk category 1 .......................................................................... 42422 Manufacturing of footwear for risk category 2 .......................................................................... 42433 Outer Sole: .................................................................................................................................. 42433 Midsole (Bottom of the footwear (the middle portion between the outer sole and insole):.... 42444 Rocker sole modification: ........................................................................................................... 42444 Basic function:............................................................................................................................. 42444 The general biomechanical effects: ............................................................................................ 42444 Rocker sole: …………………………………………………………………………………………………………………….…..….4545 Types of individualualized rocker sole ........................................................................................ 42466 Customized rocker sole constructions ........................................................................................ 42466 Manufacturing process ............................................................................................................... 42477 7 Fixation of outer sole and the bottom ........................................................................................ 42477 Insoles: .......................................................................................................................................