Pro-Corn - O&P Library

Conclusion
For 20 years at the Gillis W. Long Hansen's
Disease Center in Carville, Louisiana, Plastazote®
sandals have proven to be an effective
form of interim footwear for insensitive patients.
The technique is simple and highly
adaptable to many types of foot therapy.
References
"A Report of the National Diabetes Advisory Board,"
1
NIH Publication No. 81-2284, Bethesda, Maryland, November,
1980. p. 25.
2
Boulton, A.J.M., M.D., C.A. Hardisty, M.D., R.P.
Betts, Ph.D., C.I. Franks, Ph.D., R.C. Worth, MD., J.D.
Ward, M.D., and T. Duckworth, M.D., "Dynamic Foot
Pressure and Other Studies as Diagnostic and Management
Aids in Diabetic Neuropathy," Diabetes Care, 6, June,
1983, pp. 26-33.
3 Duckworth, T., M.D., A.J. Boulton, M.D., R.P.
Figure 11. Leather can be used for sandals intended
Betts, Ph.D.. C.I. Franks, M.D. and J.E. Ward, M.D.,
for long-term or outdoor wear.
"Plantar Pressure Measurements and the Prevention of
Ucleratioπ in the Diabetic Foot," The Journal of Bone and
Joint Surgery, 67, January, 1985, pp. 79-85.
is thin and atrophied, softer materials such as
Karat, S., M.D., "The Role of Microcellular Rubber
4
beta-pile can be used as straps.
in the Preservation of Anaesthetic Feet in Leprosy," Leprosy
Review, 40, July, 1969, pp. 165-170.
Milgram, JE., M.D., "Office Measures for Relief of
5
Considerations for Insensitive Feet
the Painful Foot," Journal of Bone and Joint Surgery,
July, 1964, pp. 1095-1116.
46,
In a series of 41 diabetic patients with sensory
Pati, L., M.D. and F. Behera, M.D., "Metatarsal
6
neuropathy in their feet, when measured Head Pressure (M.H.P.) Sores in Leprosy Patients," Lep­
rosy in India. 53, October, 1981. pp. 588-593.
with pedobarograph, 51% had abnormally high
7
Price, E.W., M.D., "Studies on Plantar Ulceration In
pressure under their metatarsal heads. 2
This is Leprosy VI, The Management of Plantar Ulcers," Leprosycompared
to only 7% of non-diabetic patients
displaying higher pressures. The skin under the
Review, 31:3, July, 1960, pp. 159-171.
8
Reed, J.K., RPT, "Plastazote® Insoles, Sandals, and
Shoes for Insensitive Feet," Surgical Rehabilitation in
metatarsal heads has been shown in many
Leprosy, Editors F. McDowell and CD. Enna, Williams
studies to be the most frequently ulcerated part and Wilkins, 1974, pp. 323-329.
of the insensitive foot. 3 , 6
9
The forefoot region of
Ross, W.F., M.D., "Footwear and the Prevention of
insensitive feet needs a higher level of protection
than the rest of the foot. This can be accomplished
Ulcers in Leprosy," Leprosy Review,
pp. 202-206.
33, February, 1962,
in the Plastazote® sandal by
10
"Selected Statistics on Health and Medical Care of
Diabetics," The National Diabetes Data Group, 1980, pp.
making the sole rigid and creating a rocker effect
in the sole design. 7
11
A-3.
A rigid sole minimizes
Tuck, W.H., C.P.O., "The Use of Plastazote® to Accommodate
shear between the sandal and skin. It also eliminates
flexion and extension at the metatarsalphalangeal
Deformities in Hansen's Disease,"
Review, 40, July, 1969, pp. 171-173.
Leprosy
joints. 7
If the toes of the foot are
rigid, a flexible soled shoe will press up into Authors
the toes during gait.
William C. Coleman, D.P.M., is Chief of the Podiatry
Rocker soles have been shown to greatly reduce
Department at the Gillis W. Long Hansen's Disease
foot pressure during gait. The point on the
sole where rocking begins should always be
posterior to the metatarsal heads, but ideally
Center, Carville, Louisiana 70721.
Arthur Plaia, M.S., is Chief of the Orthotic Department,
Gillis W. Long Hansen's Disease Center.
would be placed near the middle of the sandal.
These rocker styles of sole are also helpful in
the rehabilitation of patients with fused ankles. 5