More than 400,000 people in Singapore are living with diabetes, with nearly a third of the population unaware that they have the disease, which remains unchecked. People with diabetes often suffer from foot conditions, such as recurrent diabetic foot ulcers, untreated wounds, and infections, making them both costly and leading to an increased prevalence of amputations. These conditions make up one-third of the direct cost of diabetes care.
With the right orthotic therapy and diabetic insoles, research has shown that many of these conditions can be resolved through offloading and reducing pressure on the afflicted diabetic foot. Through this treatment method, the rate of recurrent foot ulcers can be reduced from 79 per cent to 15, significantly reducing the risk of amputation to only 6 per cent.
One of the common conditions patients with diabetes suffer from is motor neuropathy. Neuropathy is when the nerves are damaged due to the high glucose levels in the blood. Motor neuropathy occurs when the damaged nerves impede muscle control, leading to deformities in the foot. These deformities can affect your walking and create abnormal pressure on the bony areas of the foot.
Over time, this alteration in pressure can lead to the development of calluses and eventually ulceration if not treated. Ulceration in diabetic feet is extremely serious and must be dealt with swiftly to prevent worse outcomes, including amputations.
To avoid calluses and eventually ulcerations from forming, patients with diabetes can try to offload the pressure on their feet through a multidisciplinary podiatric therapeutic approach, including insoles for diabetic neuropathy.
Our custom diabetic insoles ensure that the pressure on areas more prone to calluses or undue pressure is offloaded to reduce the risk of ulcerations.
The Foot Practice’s Total Contact Diabetic Orthotics aims to improve the foot’s function in people with diabetes and provides cushioning and offloading to high-pressure areas.
A soft, semi-rigid or rigid material can be used as the base of the orthoses to offer better foot function, whilst softer cushioning materials with accommodative modifications can be used to redistribute high-pressure areas at the forefoot.
How Effective Is Orthotic Therapy in Patients with Recurrent Diabetic Foot Ulcers
In Singapore, one in three individuals is at risk of developing diabetes in their lifetime, with more than 400,000 people living with the disease today.
Throughout their disease, 15 to 25 per cent of people with diabetes will develop a diabetic foot ulcer in their lifetime, with ulcerations being the leading cause of diabetes-related hospital admissions. Furthermore, one in five ulcers will result in amputation of the lower limb. If a patient with diabetes develops Charcot’s foot, the chances of amputation after an ulcer develops increase to 50 percent.
For diabetics, foot health is essential as they have a higher risk for foot ulcers, diabetic peripheral neuropathy, foot infections, and elevated plantar pressures. One effective treatment to reduce recurrent diabetic foot conditions is orthotics treatment.
A study examining the effectiveness of orthotic therapy uncovered that recurrent diabetic foot ulcers occurred in 79 per cent of diabetic patients, with amputation as high as 54 percent of all patients. However, with a combination of custom diabetic insoles and the proper footwear selection, that rate of re-ulceration decreased to 15 percent with only a 6 per cent rate of amputation.
When orthotic therapy is combined with other podiatry treatments, the long-term outlook of preventative treatment is more sustainable and cost-effective than invasive surgical procedures and unfortunate outcomes, such as amputation. Rather than wait for the issue to arise, orthotic management of diabetic foot can provide early intervention on the afflicted foot to prevent conditions from occurring.
Pioneering Diabetic Foot Management in Singapore
Orthoses can also be used with other treatments, like modifying footwear, altering lifestyle habits, and regular podiatric assessments. The current standard of care for diabetic foot ulcer prevention includes:
- Diabetic foot screening
- Regular foot care assessments
- Therapeutic shoes
- Diabetic offloading insoles to reduce high plantar pressure and accommodate foot deformities
- Diabetic foot education for both the patient and their caregiver
At The Foot Practice, we complement the above protocols with gait retraining to shift biomechanical movement patterns to loading and footstrike.
For people with diabetes, high plantar pressure from walking, standing, or simply sitting increases the risk of plantar ulcerations. The cumulative effects of repetitive plantar pressures during daily activities over months can cause soft tissue damage and/or restrict blood circulation and flow, which increases the risk of ulcerations. As mentioned, ulcerations can be extremely dangerous for patients with diabetes, greatly increasing their chances of amputation.
Diabetic peripheral neuropathy restricts the ability to feel and detect abnormally high cumulative plantar loading. This can alter walking patterns, as the body cannot feel the pressure on the foot. Over time, this alteration in gait can create deformities in the foot and reduce ankle dorsiflexion. This can result in calluses, bunions, damage to the forefoot, and/or corns.
Total Contact Diabetic Insoles first work to offload the pressure on the foot to prevent these secondary conditions from occurring. These insoles and other therapeutic footwear recommendations from your podiatrist can accommodate foot deformities and decrease the risk of foot ulcers.
When combined with a 3D Gait Analysis into the overall diabetic foot treatment, The Foot Practice podiatrists can locate abnormalities in your gait using advanced technology to record your walk and measure pressure on your feet over time. A podiatrist can develop a treatment plan to retrain your gait to change plantar loading and footstrike patterns. Using that data, your podiatrist will provide foot mobilisation and exercises to increase foot mobility and alleviate the pressure on your feet, thus preventing any diabetic foot conditions.
The Foot Practice podiatry team specialises in treating conditions related to diabetic feet. Our custom-made orthoses for diabetic foot conditions are integral for people living with diabetes. We provide one of the best diabetic insoles in Singapore. Our orthoses are custom-designed in conjunction with Footworks, a leading Australian laboratory offering state-of-the-art polyamide and carbon-fibre orthoses.
Orthotic therapy, coupled with our pioneering 3D biomechanical gait analysis retraining and foot mobilisation therapy, can work to offload abnormal pressure for people with diabetes.
