Medicated Footwear Literature Review

In the following case study, the author will discuss the issues surrounding a seventy-year-old female with a chronic neuropathic ulcer on the sole of her right foot and the rationale and implications of

Also a repeated measure ANOVA was used to test differences between footwear conditions in eccentric and concentric phases by intensity. Using ANOVA versus conducting multiple T-test was a benefit to the study. ANOVA decreases the chance of making a type 1 error. If there was statistical significance identified from the analysis a post hoc test was ran to help identify where the significance came from. In this study statistical analysis was performed using PASW

After a review of the clinical information provided by Integra Partners, LLC, the Medical Director has determined that the orthopedic footwear and foot inserts is not medically necessary. The information submitted by the provider is limited and there is no other source of information to support the medical necessity for these services. There is no past medical history of previous care of the feet and what the result of that care has been. There is no information as to why orthopedic shoes and custom inserts are needed at this time. There is no record of your evaluation in the submitted material. We recommend you have evaluation by your doctor and complete the required documentation then submit it for consideration in the future for needed orthotic

It is estimated that 387 million people, globally live with diabetes (Phillips & Mehl, 2015). According to Medical News Today [MNT], diabetes is a metabolic disorder; which causes patients to be extremely thirsty and produce a lot of urine. Diabetes arises due to high blood pressure, due to the body not being able to produce enough insulin or because the body does not respond well to high insulin levels (MNT, 2016). There are four types of diabetes; there is the pre-diabetic stage, type 1 diabetes, type 2 diabetes and gestational diabetes. In 2014, 29 million people died due to diabetes. This equates to 1 diabetic patient dying every seven seconds due to preventable complications (including complications affecting lower limbs) caused by diabetes. It is said that 20-40% of health care costs are spent on the treatment of lower limb complications due to diabetes. The risk of a diabetic patient developing a foot ulcer is 25% and foot ulcers account approximately 85% of lower limb amputations. Diabetic complications that affect lower limbs are caused by both type 1 and type 2 diabetes (Phillips & Mehl, 2015). It is said that the World Health Organization described diabetic foot syndrome as including all possible complications in relation to the feet of a diabetic patient. Diabetic foot syndrome is defined as the ulceration of the foot, from the ankle downwards. Causes of foot ulceration include peripheral sensory neuropathy, vascular disease (ischaemia) and infection

venous leg ulcers and diabetic foot ulcers. Canadian Association of Wound Care (CAWC) has published

Vascular diseases that prevent blood flow to the small vessels are common in people with diabetes. This condition can affect the feet in particular, so you should make regular visits to a podiatrist. People with diabetes also have a reduced ability to heal even minor blisters and cuts. A podiatrist can monitor your feet for any serious infections that could lead to gangrene and amputation.

After the initial investigation, the BSN nurse would then research current treatments for pressure ulcers as they relate to diabetic patients. To properly care for a diabetic foot ulcer, the BSN nurse would suggest debridement and a dressing to prevent tissue dehydration, absorb excess fluid, and to prevent wound contamination (American Diabetes Association 2006). Patient education would also be necessary to ensure she does not bear weight on the affected limb to promote healing. According to the American Diabetes Association, the biggest challenge for healing a diabetic wound is keeping the patient from bearing weight on the affected limb. The BSN nurse may be equipped to handle the patient education better than the ADN nurse due to the amount of research done on the subject.

The goal to treat an ulcer in a diabetic patient is to heal the wound faster to prevent infection, pressure has to be take off the area by “offloading” the foot, remove dead tissue by the process of debridement, apply to dress per doctors order, and focus on managing the patient’s blood sugar effectively to promote healing. In addition, to prevent infection, the patient must keep the dressing clean, cleanse the wound daily and change the bandage and dressing, the patient must also avoid walking on barefoot.

Instruct the patient to wear non-skid footwear, considering the type and condition of footwear such as ill-fitting shoes or incompatible soles

The recommendations for change to practice at the level of the provider would include first treating the underlying problem that Mrs. Smith was admitted for. According to the literature, a progressively worsening diabetic foot ulcer involves implementing a multitude of strategies to prevent amputation of the limb. This allow for decreased rates in mortality and can increase quality of life. Adequate wound management such as debridement, and offloading techniques should be instilled. Furthermore, education by the provider would be of critical importance for Mrs. Smith in terms of consistent foot care and management of her disease process (Yazdanpanah, Nasiri, & Adarvishi, 2015). Due

Diabetic Peripheral Neuropathy (DPN) is one of the most common microvascular complications in diabetes and can result in foot ulceration, ampuation and an impaired quality of life(Carrington AL, et al 2002,Boulton AJ,et al 2004). The reported prevalence of diabetic peripheral neuropathy ranges from 16% to as high as 66%2 and its prevelance is believed to increase with the duration of diabetes and poor glucose control.(Boulton AJ.et al 2000) It’s accounts for 50–75% of non-traumatic amputations in diabetic patients.(Holzer SE, et al 1998, Boulton AJM, 1998,Malay DS, et al 2006)

Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, Tamborlane WV, Beck RW, Bode BW, Buckingham B, Chase HP, et al. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med. 2008 Oct 2;359(14):1464-76. Epub 2008 Sep 8.

stated that he wears a size ten shoe however he does not own a pair of shoes in his size. With all these factors involved it becomes obvious that J.L. is a diabetic patient in need of foot care teaching, in order to prevent further complications.

Foot injuries are very common in athletics as well as in everyday life. It’s very debilitating to have a foot injury since we use our feet in all of our daily activities. Research published in "Medicine and Science in Sports and Exercise” indicates that the average adult takes between 5,000 to 7,000 steps a day. Some sports require the most dedicated athletes spend multiple hours a day pounding their feet on the turf or pavement. Most injuries that occur in the foot require a person to try and stay off of it or completely immobilize it. Since this is very difficult for a person to do, a large percentage of foot injuries often have a very high chance of reoccurring. The severity of some injuries that can be deceiving as well. Often times a nagging pain is ignored and eventually becomes a much bigger problem.

The diabetic foot disease is the leading cause of non-traumatic lower-limb amputation and results from three common pathologies: diabetic peripheral neuropathy, peripheral arterial disease, and infection. Late complications include foot ulceration, Charcot neuroarthropathy and amputation (Turns, 2013, p.422) though another specialist like, Iraj who wrote Prevention of Diabetic Foot Ulcer, added to the most common facts: deformities and minor