1. Orthotic Solutions for
Complications develop
in foot related to
Diabetic
Apeksha
(Endolite Lanka)

2. What is an Orthosis?
 An Orthosis is a device which is fitted to the
outside of the body to support a weakness,
correct a deformity, prevent a
deformity/contracture, promote healing, direct
growth, enhance function with better positioning,
maintain joint stability, decrease pain and/or
inflammation, and/or to rest and support
weakened structures.

3. Lower limb Orthosis
 FO- foot Orthosis

4. Lower limb Orthosis
 AFO- Ankle Foot Orthosis

5. Lower limb Orthosis
 KAFO- Knee ankle Foot Orthosis

6. Stages of Diabetic foot
Callus
Inflammation Ulcer
Infection
Abscess
GangreneAmputation

7. Complication related to Diabetic
Callus
 One of the body’s first reactions to pressure is to create a callus. A Callus is
made up of dead skin cells that are piled up on one another and form a hard
layer. The role of the callus is to protect the skin underneath. But when
calluses get thick in weight bearing areas, they actually put additional
pressure on the skin underneath.

8. How to deal with a callus
1. Medial arch support to increase the area of weight bearing and reduce
pressure ,
2. Dome or Bar Support to reduce pressure from MT heads And to reduce
Clow toes as well
3. Use, well fitting extra Depth shoe to insert a FO

9. Ulcer
 After the WBC have removed the damaged tissues they should be replaced
with new tissue, but the patient keeps walking, keeps applying forces and the
tissue keeps getting damaged. This leads to a “hole” forming in the skin, an
open sore we call an ulcer.

10. 1. Ulcer can be treated with FO in early stage.
2. If the infection happen and when its in a condition of abscess .its usually
need to reduce the motions over ankle and mid foot , so the inflammation
will be reduce, FO will be not enough to do that. then we go for AFO
3. If fore foot ulcer its use Rigid AFO, and IF heel ulcer need to use PTBAFO.
4. With a Rigid AFO and PTB AFO we may need to do shoe modification to get
easy roll over at 3rd rocker.

11. Charcot foot / Charcot Joint / Charcot Arthropathy / Rocker bottom foot.
 Injury to an insensate foot (ulcer, sprain, micro fracture)
 Inflammation and increased blood flow to the area
 Increased blood flow leads to reabsorption of minerals from the bones, making them weak.
 Weakened bones fracture under “normal” stresses.
 This cycle then feeds itself and the rate of deformity can accelerate. As deformity increases,
abnormal forces are generated on the structures of the foot, again leading to further damage.
 It is common to see a plantar ulcer on the mid-foot of the Charcot foot, as the foot takes up a
convex shape forces are focused on the boney midfoot area.

12. Rigid AFO PTBAFO
 Offload the foot and promote
heeling of the ulcers
 Protect the Foot Structure
 Immobilize the foot so it helps
to reduce the inflammation.
 Unlike Total contact cast
patient can remove when not
walking.
 patient can still walk so blood
circulation also encourage.
Total contact casting is normally used .but,
Same function can be achieved with PTB AFO and Rigid AFO
 Offload only the fore foot
and promote heeling of
the ulcers
 Protect the Foot Structure
 Immobilize the foot so it
helps to reduce the
inflammation. Unlike Total
contact cast patient can
remove when not walking.
 patient can still walk so
blood circulation also
encourage.

13. Amputation
 When an infection / abscess / gangrene can not be treated the affected
tissues must be removed surgically, otherwise the death of tissues can lead to
septicemia (poisoning of the blood) or a “chain reaction” of tissue death.

14. How to Make a Orthosis
1. Do the Subjective assessment of patient( Age, Occupation , Family background)
2. Do objective assessments (Mussel Strength, Range of motion of the Joints, Gait
analysis in Sagittal and Coronal planes.
3. Make Orthotic Objective with the assessment and Prescribe the suitable device
4. Take a Cast of the limb
5. Fill the Negative cast and get a Positive cast, and do the rectification of the cast.
6. Do the Fabrication.
7. Dot the Fitting of the Device with patients
8. Adjust the device with Dynamic and Static and get the out come as in orthotic
Goals
9. Deliver the device with proper device caring details.
10. Have follow up with patients…….

15. Thank you!