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Educating Patients on Shoe and Orthotic Design in Diabetic Foot Care
Guest post by David Sutton, Senior Pedorthist at Bilby Shoes
Patient education is one of, if not the most important things we do in the clinic. Patients can lose sensation in their feet due to diabetic neuropathy or other causes. This loss of feeling means patients don't always notice injuries such as blisters, cuts, or infections caused by pressure imbalance and overloading. This can rapidly progress to severe ulcers, infection, and potential amputation. 
400kPa Foot Pressure SiteIn our clinic, we often don't do ISPM (in shoe pressure mapping) of a patients existing footwear as it has no effect on our assessment or the prescription.
For typical patients, we only use barefoot objective data to move forward with our prescription. But some patients ask "Why do l need new shoes, these feel fine" even though they may have an ulcer.
For that reason, we sometimes need to measure the existing footwear and spend time educating the individual of the cause and effect of the existing footwear and why they are not working for them.
The cause of a foot ulcer can be joint disfunction, boney prominence, high peak pressure values, diabetes and sometimes shear.
In this case, we scanned a patient and identified an ulcer site under the 2nd MPJ (Metatarsophalangeal Joint). The ISPM (In-Shoe Pressure Mapping) data is an average of 8 steps of each foot. The data collected is of the highest resolution ISPM system available, the F-Scan GO.
When we show a patient the data, 400kPa in the same area (see image at right), the reason they need better footwear and orthosis becomes clear. We explain to them that 200kPa is the target set by Diabetic Feet Australia (DFA) and the International Working Group on the Diabetic Foot (IWGDF).
When the patient sees the visual data, they understand why the treatment is so important. Adherence to offloading devices is based on patient education, understanding and acceptance.
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David Sutton is a senior Pedorthist at Bilby shoes and orthotics, a specialist in pressure mapping, in-shoe and pressure mats for Gait assessments. Clinical advisor to S.W.E.P, Clinical advisor to Tekscan, trainer and distributor for Australia and New Zealand.
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