Consumer Education

What Is Pedorthics And How Can I Learn More?

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Animated Video Explains Diabetes 

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Diabetes - An Epidemic See 2013 Facts Below 

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Pedorthics (peh-DOR-thiks)

What IS a Credentialed Pedorthist? And Why Should I See One?

Q: What IS a Credentialed Pedorthist? And Why Should I See One?

A: A credentialed pedorthist is a specialist in using footwear - which includes shoes, shoe modifications, foot orthoses and other pedorthic devices - to solve problems in, or related to, the foot and lower limb.

When a foot requires medical attention, footwear becomes a factor in the patient's treatment, recovery or rehabilitation. It's a team approach: While the doctor treats your foot, the credentialed pedorthist addresses your footwear needs.

Q: What is "pedorthics”?

A: Pedorthics (peh-DOR-thiks) is the management and treatment of conditions of the foot, ankle, and lower extremities requiring fitting, fabricating, and adjusting of pedorthic devices.

Q: How does the team approach work?

A: When appropriate, doctors refer patients to specialists - and credentialed pedorthists are specialists in using footwear to address lower-limb-related problems and pathologies. Credentialed pedorthists understand the properties of footwear, and the interaction between the patient's foot and shoe. Credentialed pedorthists are also skilled at evaluating feet and fitting footwear. After your physician has determined what kind of assistance your footwear should provide for you, a credentialed pedorthist can fill the prescription.

Q: What do credentialed pedorthists actually do?

A: They select and modify footwear (or make it, if necessary) to help people maintain or regain as much mobility as possible. When your ability to walk is affected, everything that surrounds or touches your foot - whether it's foot orthoses, shoes, boots, slippers, sandals, socks, hosiery, night splints, bandages, braces, partial-foot prosthetics or other devices - interacts with your foot. That makes footwear a crucial part of your recommended treatment plan. Footwear adjustments can be made inside or outside a shoe.

Foot orthoses, also called orthotics, are an important component of footwear that can accommodate, support or relieve specific conditions, as well as improve the foot's function. In addition to designing and fabricating an appropriate orthotic, a credentialed pedorthist can provide you personalized attention in selecting, fitting and modifying shoes so that you can wear the orthotic effectively. Credentialed pedorthists follow up to make sure the footwear functions as your doctor prescribed. A footwear prescription, like any other prescription, takes into account your medical history, activities of daily living, and treatment goals.

Q: What kinds of problems does a footwear prescription address?

A: Pedorthics gives physicians a whole range of conservative - or non-surgical - treatment options. Increasingly, doctors and other qualified prescribers write footwear prescriptions to relieve pressure, redistribute weight, accommodate or support conditions, prevent injuries, compensate for imbalances or overuse, and preclude the worsening of damage to the foot. In addition to addressing lower limb problems, footwear prescriptions can address foot-related problems, such as lower back pain, pelvic imbalances, or other limits to your physical ability to perform. Footwear prescriptions can even help athletes return to their sports faster from some minor injuries.

Q: What qualifies someone to be a credentialed pedorthist?

A: People coming into pedorthics study foot and lower limb anatomy; pathology; biomechanics, which involves human locomotion; gait analysis; footwear fitting; lower extremity orthotic design, fabrication and materials; shoe construction and modification; and patient/practice management. In addition, most seek non-academic experience under the supervision of a credentialed pedorthist to familiarize themselves with pedorthic approaches, terminology and techniques. After studying and being mentored, they attend specific pedorthic courses which are prerequisites for their certification examination. Credentialed pedorthists maintain their certification by following continuing education and renewal requirements.

Q: My feet sometimes bother me, but I don't need a doctor, I just need more comfort in my shoes. Can a credentialed pedorthist help with that?

A: Yes. Many people can benefit from pedorthic devices or footwear modifications to make their shoes more comfortable. Sometimes they just need a shoe that has been properly fit. You can see a credentialed pedorthist without a footwear prescription, but some credentialed pedorthists prefer to work by appointment, to assure they can give your feet the attention you deserve. Keep in mind that if you have a medical condition, you will need a footwear prescription before the credentialed pedorthist can help you.

Q: Where can I find a credentialed pedorthist?

A: The Pedorthic Footcare Association's website (www.pedorthics.org) maintains a searchable directory of member credentialed pedorthists. Many of them are in private practice; others work at hospitals, clinics, shoe stores or other facilities. If you don't have a computer at your home or office, check with your local library for web site assistance.

Patients may be eligible through health insurance for partial or full reimbursement for footwear prescribed to accommodate or alleviate medical conditions.

This page contains generalized information. Use of specific words within this generalized framework is not intended either to reflect or to contradict technical pedorthic definitions. Nothing in this brochure should be interpreted as a substitute for professional consultation.

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 2013 Diabetes Facts & Figures

Diabetes affects 26 million people in the US and more than 366 million people worldwide.
Diabetesatlas.org/American Diabetes Association

The top 10 diabetes nations 
International Diabetes Federation / Diabetesatlas.org
 
Diabetes kills more people annually than breast cancer and AIDS combined.
American Diabetes Association, 2009

80% of people with diabetes are from low and middle income nations
International Diabetes Federation, 2012

The number of people with diabetes is increasing in every single nation
International Diabetes Federation/World Health Org 2012

Half of people with diabetes don't know they have it.
American Diabetes Association / International Diabetes Federation, 2012

Quiet. Slow. Deadly. Expensive: Chronic Diseases Account for 75% of our Healthcare Costs.
Seconds Count: Every 7 seconds someone dies from diabetes. Every 20 seconds someone is amputated. 
International Diabetes Federation / Diabetesatlas.org
 
Diabetic Foot Ulcer patients are twice as costly to US Medicare as those with diabetes alone
Rice, et al, ISPOR, 2013

Inpatient care constitutes nearly two thirds of insurance costs for diabetic foot ulcers
Rice, et al, ISPOR, 2013

The estimated annual US Burden of Diabetic Foot Ulcers is at least $15 Billion
Rice, et al, ISPOR, 2013
 
By 2030, at least 550 million people will have diabetes - approximately 10% of the world's adult population.
International Diabetes Federation (IWGDF), 2011

There are now approximately 79M people with pre-diabetes in the USA
That is the equivalent of the total population of 30 states. 
American Diabetes Association, 2012
2010 United States Census

The population of diabetes in the USA is greater than the population of the nation's 10 largest cities.

American Diabetes Association, 2012
2010 United States Census

The population of Diabetes in Arizona (home of SALSA) would make it the fourth largest city in the state.

American Diabetes Association, 2012
2010 United States Census
 
60-70% of those with diabetes will develop peripheral neuropathy, or lose sensation in their feet.
Dyck et al.  Diabetic Neuropathy 1999
 
More than 90% of people with diabetic peripheral neuropathy are unaware they have it.
Bongaerts, et al, Diabetes Care, 2013
 
Up to 25% of those with diabetes will develop a foot ulcer.
Singh, Armstrong, Lipsky.  J Amer Med Assoc 2005
 
The yearly incidence of diabetic foot ulcers ranges from 2% to 32%, depending on ADA risk classification
Boulton, Armstrong, et al, Diabetes Care 2008
Lavery , et al, Diabetes Care  2008
Sibbald, et al, Adv Skin Wound Care, 2012
 
More than half of all foot ulcers (wounds) will become infected, requiring hospitalization and 20% of infections result in amputation.
Lavery, Armstrong, et al.  Diabetes Care 2006
 
Diabetes contributes to approximately 80% of the 120,000 nontraumatic amputations performed yearly in the United States.
Armstrong et al. Amer Fam Phys 1998
 
"Every 20 seconds, somewhere in the world, a limb is lost as a consequence of diabetes"
DFCon11, Bakker (after Boulton), DFCon.com
Boulton, The Lancet (cover), Nov. 2005
 
After a major amputation, 50% of people will have their other limb amputated within 2 years.
Goldner. Diabetes 1960
Armstrong, et al, J Amer Podiatr Med Assn, 1997
 
More than half of people with osteomyelitis of the heel will undergo high level amputation
Faglia, et al, Foot Ankle Int, 2013
 
The relative 5-year mortality rate after limb amputation is 68%. When compared with cancer – it is second only to lung cancer (86%).  (Colorectal cancer 39%, Breast cancer 23%, Hodgkin's disease 18%, Prostate cancer 8%)
Armstrong, et al, International Wound Journal, 2007
Amer Cancer Society; Facts & Figures 2000
Singh, Armstrong, Lipsky et al. J Amer Med Assoc 2005
Icks, et al, Diabetes Care, 2011
 
Median time to healing for diabetic foot wounds: 147,188, and 237 days for toe, midfoot and heel ulcers.
Pickwell, et al, Diabetes Metab Res Rev, 2013 
 
People with a history of a diabetic foot ulcer have a 40% greater 10 year mortality than people with diabetes alone.
Iversen, et al, Diabetes Care, 2009
 
Every 30 minutes a limb is lost due to a landmine.
Every 30 seconds, a limb is lost due to diabetes.
Bharara, Mills, Suresh, Armstrong, Int Wound J, 2009
 
  1. Having a wound immediately doubles one's chances of dying at 10 years compared with someone without diabetes.
  2. Iversen, et al, Diabetes Care2009
     
    One third of patients seeking care for ischemic wounds die unhealed
    Elgzyri, et al, Eur J Vasc Endovasc Surg, 2013

    For people on dialysis receiving an amputation, 2 year mortality is 74%
    Ndip, et al, 2012, Diabetes

    Diabetic foot ulcers double mortality and heart attack risk while increasing risk for stroke by 40%
    Brownrigg, et al, Diabetologia, 2012

    Chronic wounds affect some 8 million Americans each year. That's one wound every 3.8 seconds in the USA, alone.
    Harsha , 2008 and Tomic-Canic 2010

    Each $1 invested in care by a podiatrist for people with diabetes results in $27 to $51 of healthcare savings.
    JAPMA, 101(2), 2011

    Podiatry care not only reduces amputation risk, but also dramatically impacts rate of hospitalization and reulceration

    Gibson, et al, Int Wound Journal, 2013

    Podiatric medical care in people with history of diabetic foot ulcer can reduce high level amputation from between 65% and 80%
    Gibson, et al, Int Wound Journal, 2013

    Instituting a structured diabetic foot program can yield a 75% reduction in amputation rates and a near four-fold reduction in inpatient mortality
    Weck, et al,  Cardiovascular Diabetology, 2013
Our Response To A Recent Question:

New Question: Would like to ask for some suggestions on this following patient/customer:

She came in complaining about blisters in her arch after running. See picture below.

She had brought her running shoes (purchased somewhere else); so I asked her to put them on and let me check the fit.

The shoes fit great. Gait evaluation also showed that the shoe model should be a good fit for her.

She wears running socks, no orthoses and gets the blisters if she runs more than 10 miles. 

It's got to be some shearing, correct? Re-laced her shoes, suggested to try some other socks. Other suggestions?

- K. Reichl, CPed. BOCPED

In response to the blister case:

The simplest answer and easiest fix is Vaseline on the feet, a women’s nylon and then appropriate socks, or a scaphoid pad in the shoe to control excessive motion – excluding  the following more thorough recommendations:

In my experience, I have seen this type of situation many times, but as far back as I can remember - only from wearing orthoses - for two reasons 1) they accelerated their wearing time 2) the orthoses were not controlling the foot well enough and I needed to increase correction (medial extrinsic (or remake the device with more intrinsic) rearfoot control or sometimes extrinsic forefoot control (runner's wedge/kinetic wedge). Sometimes and rarely I will increase the arch with a scaphoid; (remember doing so may stop the natural plantarflexion of the first ray). In this case, you mentioned the customer/patient wasn't wearing orthoses. Taking into consideration foremost that this is a biomechanically oriented pathology and not a foreign body, wart, seed corn, cancerous lesion, a systemic issue causing edema that makes the shoe too snug, etc. and then excluding designs of the shoe that may be causing irritation or the patient wearing two pairs of socks and making the shoes too narrow...I would place my visual assessment of the foot at the forefront. Meaning, I would visually assess whether there was signs of mild pes cavus or pes planus (most common with these lesions) with heel valgus, medial drift or vertical drop of the navicular/talus, base of the first ray vertical drop or medial deviation or any signs of abductory shifting of the forefoot - all in closed chain position. If so, my rule is to offer biomechanical control with an OTC arch support i.e.: for slight to mild rearfoot valgus - a Superfeet or similar, for moderate to large rearfoot valgus - a Powerstep or similar, for high to excessive rearfoot valgus - a Quad 24 or a custom product.  If the patient had other biomechanical symptoms in the past or present, I would consider a custom product.  However, most importantly I would hold the patient's heel with my right hand, cupping it as to lock it from movement. I would take my opposite hand and wrap it around the metatarsal heads with my fingers on the dorsal aspect of the foot and my thumb on the plantar aspect of the metheads (all five, as best as possible - to control them). With gentle traction on the calcaneus/ankle with one hand, the left hand would invert the forefoot in a supinated position to "end-range-motion". If the foot measured 45 degrees of movement, this is WNL/Low Motion. If it measures 60 or above that is considered Medium Motion, if it measures over 70 degrees, that is considered excessive motion/High Motion or it may be hypermobile. Next I would check the ability of the first ray to dorsiflex and plantarflex while keeping the hindfoot locked with traction. This will help you to know if the forefoot is stable or unstable and the first ray stable or unstable. These are signs that the patient needs a custom foot orthosis. We firmly believe our role is to analyze the human foot and offer preventative options if we see malalignment or restricted or excessive motion. This is a great time to show your talents as a healthcare practitioner and prevent long term issues that may slowly be presenting with a shear/friction/blister.

This range of motion series I am explaining can be sent via PPT to you with written narration on how to perform it. I hope this helps.  Your patient will be impressed and you will build a reputation as an analyzer. Sometimes we (including myself) may be intimidated to know when to make a stand for biomechanical control. I stand on the shoulders of the physicians who mentored me and our belief is that  range of motion and visual assessment plus symptoms is the “green light” to go educate and prevent!

Pam Haig, C.Ped.

Pedorthic Newswire Advisor

editor@pedorthicnewswire.com

 

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