Diabetic gait is a complex and often debilitating condition that can lead to serious foot problems, including ulcers and amputations. It is characterized by a number of biomechanical abnormalities.
The prevalence and consequence of a diabetic foot ulcer (DFU) remains a devastating life altering event which continues to be a major contributor to our medical and public health challenges. These chronic wounds encompass complexities which have a long-term impact on patients’ morbidity, mortality, and quality of life. - Lower Extremity Review: Welcome To The Reality Of Diabetic Foot Ulceration
In order to prevent diabetic foot ulcers and improve limb preservation rates, here are recommendations that podiatrists should implement during each stage of diabetic patient treatment.
Examination Stage
The initial examination allows you to assess diabetic risk factors and develop personalized treatment plans.
During the examination of a patient with diabetic gait, be especially attentive for the following:
1. Is the Patient Neuropathic?
This may lead to “blind gait” due to impaired proprioception and sensory feedback. This type of gait is characterized by a flat-footed gait with a short stride length. Patients land flat footed where their initial contact is on the mid foot and rocks back before mid-stance and heel off because they are unsure of their foot position.
2. Does the Patient Have a Limb-Length-Discrepancy?
This is common in people with diabetes due to nerve damage. Limb-length discrepancy is important to check for because the longer limb will pronate and can lead to more forefoot pressure, especially around the 1st metatarsal head and hallux. In many cases addressing this early is vital to prevent ulcers from developing.
3. Does Patient Have Proper Footwear?
Shoes that are too tight constrict the feet and reduce blood flow, while shoes that are too loose can allow the feet to slide around and rub against the inside. Ill-fitting shoes can cause problems with medial, lateral and dorsal ulcers and lead to blisters, corns, calluses, and increased risk of infection.
Prescribing Proper Orthotics
Orthotics can play an important role in managing diabetic gait and preventing foot problems. There are a variety of different types of orthotics available, and the best type of orthotic for a particular patient will depend on their individual needs. Generally divided into two categories:
1. Accommodative Diabetic Device
A soft tri-laminate device like the Forward Motion Diabetic Soft is a good choice for off loading plantar ulcers or deformities. If a more rigid device is needed, a Diabetic Medium device is good for off-loading charcot deformities.
2. Functional Diabetic Device
An orthotic device with a Thermoplastic Shell and Poron reinforcement is the recommended choice for biomechanical control. Functional devices like the Motion Soft Orthotic created by Forward Motion help to prevent diabetic problems caused by excessive pronation or supination.
With both types of orthotic devices, patients will feel more confident when they have orthotics assisting them as they go through their gait cycle leading to increased stride length.
By observing the manner in which the patient walks and identifying over-burdened areas based on pressure and timing abnormalities, the podiatric biomechanical gait specialist can devise a device to effectively offload areas of risk for ulceration and improve problematic gait characteristics. - Lower Extremity Review: Welcome To The Reality Of Diabetic Foot Ulceration
Join us for our Diabetic Gait part 2 article where we will go more in-depth about using different orthotic accommodations to address different symptoms of diabetic gait!
Citation:
1. Segel et al. (2023). Welcome to the Reality of Diabetic Foot Ulceration: A Multidisciplinary Approach to Evaluation and Management Through Computer-Aided Gait Analysis & Custom Diabetic Orthoses. Lower Extremity Review