Newer offloading technics at Foot wear can heal difficult Heel DFU

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Newer offloading technics at Foot wear can heal difficult Heel DFU Powered By Docstoc
						
  

Title:	
              Newer	
  offloading	
  technics	
  at	
  Foot	
  wear	
  can	
  heal	
  difficult	
  Heel	
  DFU	
  keeping	
  Patient	
  
                      ambulatory.	
  

Author:	
  	
         Dr.	
  Sunil	
  V.Kari.,	
  Diabetic	
  Foot	
  Surgeon.	
  	
  

Instutute:	
  	
      Sou.Mandakini	
  Memorial	
  Hospital,	
  HUBLI,	
  Karnataka,INDIA.	
  

Purpose:	
            Heel	
  DFU	
  is	
  a	
  great	
  challenge	
  in	
  the	
  management	
  of	
  DFU.	
  It	
  is	
  very	
  difficult	
  to	
  	
  heal.	
  Heel	
  
                      strike	
  forms	
  the	
  first	
  step	
  in	
  Walking	
  Cycle.	
  The	
  body	
  wt.	
  transmission	
  at	
  Heel	
  is	
  
                      maximum	
  at	
  Landing	
  phage.	
  Foot	
  Biomechanics	
  plays	
  major	
  role	
  in	
  healing	
  of	
  Heel	
  DFU.	
  
                      90%	
  of	
  Heel	
  DFU	
  end	
  up	
  with	
  Calcaneal	
  osteomyelitis	
  &	
  AK/BK	
  amputation.	
  Duaration	
  of	
  
                      healing	
  	
  is	
  pretty	
  long,	
  more	
  than	
  6months.	
  Outcome	
  of	
  Heel	
  DFU	
  in	
  CRF,	
  is	
  very	
  
                      pathetic.	
  Routine	
  available	
  	
  modified	
  	
  foot	
  wears	
  for	
  offloading	
  hind	
  foot	
  lesions	
  are	
  not	
  
                      patient	
  friendly.	
  Patient	
  has	
  to	
  plan	
  to	
  shift	
  his	
  body	
  wt	
  on	
  forefoot.	
  Thus	
  Healing	
  Heel	
  
                      DFU	
  is	
  a	
  great	
  challenge.	
  We	
  have	
  simplified	
  this	
  process	
  by	
  designing	
  Footwear	
  which	
  is	
  
                      patient	
  	
  friendly	
  &	
  he	
  has	
  normal	
  walking	
  cycle	
  with	
  healing	
  within	
  3	
  months.	
  

Method:	
             We	
  plan	
  normal	
  foot	
  wear	
  with	
  normal	
  Heel	
  height.	
  The	
  heel	
  portion	
  is	
  drilled	
  square	
  
                      shape	
  as	
  per	
  DFU	
  size	
  &	
  shape.	
  The	
  drilling	
  of	
  heel	
  is	
  done	
  up	
  to	
  3/4”.A	
  40%	
  density	
  
                      foam	
  is	
  inserted	
  into	
  the	
  drilled	
  area	
  of	
  heel.	
  This	
  is	
  prepared	
  by	
  sticking	
  layers	
  of	
  foam	
  
                      of	
  on	
  one	
  another	
  which	
  adds	
  	
  body	
  wt	
  sustaining	
  capacity	
  to	
  the	
  foam.	
  After	
  this	
  we	
  
                      place	
  a	
  tapering	
  shape	
  foam	
  on	
  the	
  inner	
  aspect	
  of	
  foot	
  wear	
  with	
  heel	
  ht	
  of	
  1”.	
  




Results:	
            The	
  foot	
  biomechanics	
  does	
  not	
  add	
  body	
  wt	
  on	
  Heel	
  DFU	
  as	
  it	
  remains	
  suspended	
  in	
  	
  
                      air.	
  Heel	
  does	
  not	
  toch	
  the	
  ground.	
  So	
  the	
  healing	
  of	
  DFU	
  is	
  fast.	
  Pt	
  is	
  very	
  comfortable	
  
                      with	
  footwear.	
  

Conclusion:	
  	
     Simple	
  modifications	
  in	
  foot	
  wear	
  can	
  be	
  economical	
  &	
  effective	
  in	
  healing	
  difficult	
  	
  Heel	
  
                      DFU.	
  

				
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posted:7/20/2011
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