Supplementum 3+4/2007 - Společnost pro pojivové tkáně

significantly reduce the risk of defects of
the sole of the foot.
Treatment of already developed defects
requires cooperation between the physician,
the podiatrist and the orthotic technician.
The authors describe their experience
of interdisciplinary cooperation during
detection and treatment of sole defects.
The localization of ulceration (in the
front, middle and rear part of the foot), the
extent of the affliction, the healing stage
and the overall condition of the patient
are the crucial factors for the selection of
specific pressure relief aid.
Orthotic and footwear
management
In case of entirely external non-infected
neuropathic ulcerations local self-adhesive
relief aids are used which are applied
in the wound surroundings and reduce the
pressure on the area. Timely application of
these is crucial. It is desirable that they are
available to the front-line doctor (GP, diabetologist)
or possibly even to the educated
high risk patient.
Similarly, this holds for post-operative
shoes for relieving the front or rear part of
the foot (fig. 1). Their primary advantages
are the low price and the possibility of
immediate use and that is why this means
of relief is among the most often used.
However, it is necessary to check that the
ulceration is indeed outside the weight-bearing
regions of the sole. Otherwise, usage
of an individually-manufactured shoe or of
a different type of relief is to be considered.
Combination with crutches or a wheelchair
is eligible. The patient should be
educated about the necessary change in
the way of ambulation and the significant
reduction of foot stress. The shoes are only
meant for the most basic life activities.
Older patients suffering from vertigo
and stability disorders often refuse to
use the pressure relieving shoes or splint
because of the risk of fall and their defects
are not healing properly. In such cases
a pressure relief insole is applied, with hole
in the area of the defect or high-risk bone
prominence which reduces the direct local
pressure on the affected regions. To reduce
the deteriorative shear forces the edge
of the hole is filled with soft compressible
substance. An insufficiently compressible
material may, however, increase the
local pressure. This means requires shoes
with sufficient inner space – deep medical
shoes have proven eligible (fig. 2), meeting
the requirements for convenient shoes
for diabetic patients.
Contact plaster fixation, especially non-
-removable, is being the gold standard,
though in routine operations it is an elaborate
and expensive method which demands
erudition, experience and enough room in
the surgery. Therefore, if application of the
pressure relief shoes is not sufficient, the
removable orthoses are used for relieving
the front part of the sole (fig. 3), various
types of AFO orthoses for relieving the
pressure on the heel or Walker, VACOPED
or VACOdiabetic splints. Pneumatic Aircast
brace was also tested and has appeared
very prospectively.
Patients with severe deformity, defect
in the middle part or in the medial area of
the sole, osteomyelitis, in the acute stage
of Charcot’s neuroarthropathy or defects
of the post-amputation stumps have shown
very good results when modified Algover
orthosis with embedded stirrup for complete
relief of the sole was applied. (fig. 4)
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