Biomechanical Offloading

Jeffrey D Lehrman DPM FACFAS FASPS FAPWH

Fellow American College of Foot amp Ankle Surgeons Fellow American Society of Podiatric Surgeons Fellow Academy of Physicians in Wound Healing Fellow American Academy Podiatric Practice Management Diplomate American Board of Foot amp Ankle Surgery

Disclosures

Speakerrsquos Bureau

bull Smith amp Nephew Advanced Wound Management Division

bull BSN Medical Advanced Wound Care Division

Recurrence and prevention of diabetic foot ulcers after total contact casting

bull 28 patients treated with TCC

bull 85 healed

bull 57 had recurrenceFoot Ankle Int 2007 Jan28(1)64-9

Frigg A1 Pagenstert G Schaumlfer D Valderrabano V Hintermann B

Disclosures

Speakerrsquos Bureau

bull Smith amp Nephew Advanced Wound Management Division

bull BSN Medical Advanced Wound Care Division

Recurrence and prevention of diabetic foot ulcers after total contact casting

bull 28 patients treated with TCC

bull 85 healed

bull 57 had recurrenceFoot Ankle Int 2007 Jan28(1)64-9

Frigg A1 Pagenstert G Schaumlfer D Valderrabano V Hintermann B

Recurrence and prevention of diabetic foot ulcers after total contact casting

bull 28 patients treated with TCC

bull 85 healed

bull 57 had recurrenceFoot Ankle Int 2007 Jan28(1)64-9

Frigg A1 Pagenstert G Schaumlfer D Valderrabano V Hintermann B

Preventing Recurrance Things to Consider

bull Is the foot quiescent

bull If not need immobilization and optimally NWB

bull What is the plane of the deformity

bull Sagittal plane deformities respond more positively than transverse plane or combinations

Sagittal plane deformity

Transverse plane deformities

Frontal plane deformity

Three Deforming Forces

bull Shearingbull May control with accomodative insoles orthotics and

AFO

bull Bending bull Seen with Equinus

bull May address with heel lift (1 inch)

bull Vertical Load

Preventing Recurrance Things to Consider

Understanding of the Disease Process

Footcare Knowledge

Compliance History

Complexity of the Treatment or Therapy

Beliefs and Perceptions of Benefits

Family Support

Practitioner Reinforcement

Custom Shoe

Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial

bull 171 neuropathic diabetic patients with recently healed plantar foot ulcer

bull Custom-made footwear

bull Recurrence at 18 months

42

Diabetes Care 2013 Dec36(12)4109-16Bus SA1 Waaijman R Arts M de Haart M Busch-Westbroek T van Baal J Nollet F

Sagittal plane deformity

Transverse plane deformities

Frontal plane deformity

Three Deforming Forces

bull Shearingbull May control with accomodative insoles orthotics and

AFO

bull Bending bull Seen with Equinus

bull May address with heel lift (1 inch)

bull Vertical Load

Preventing Recurrance Things to Consider

Understanding of the Disease Process

Footcare Knowledge

Compliance History

Complexity of the Treatment or Therapy

Beliefs and Perceptions of Benefits

Family Support

Practitioner Reinforcement

Custom Shoe

Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial

bull 171 neuropathic diabetic patients with recently healed plantar foot ulcer

bull Custom-made footwear

bull Recurrence at 18 months

42

Diabetes Care 2013 Dec36(12)4109-16Bus SA1 Waaijman R Arts M de Haart M Busch-Westbroek T van Baal J Nollet F

Transverse plane deformities

Frontal plane deformity

Three Deforming Forces

bull Shearingbull May control with accomodative insoles orthotics and

AFO

bull Bending bull Seen with Equinus

bull May address with heel lift (1 inch)

bull Vertical Load

Preventing Recurrance Things to Consider

Understanding of the Disease Process

Footcare Knowledge

Compliance History

Complexity of the Treatment or Therapy

Beliefs and Perceptions of Benefits

Family Support

Practitioner Reinforcement

Custom Shoe

Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial

bull 171 neuropathic diabetic patients with recently healed plantar foot ulcer

bull Custom-made footwear

bull Recurrence at 18 months

42

Diabetes Care 2013 Dec36(12)4109-16Bus SA1 Waaijman R Arts M de Haart M Busch-Westbroek T van Baal J Nollet F

Frontal plane deformity

Three Deforming Forces

bull Shearingbull May control with accomodative insoles orthotics and

AFO

bull Bending bull Seen with Equinus

bull May address with heel lift (1 inch)

bull Vertical Load

Preventing Recurrance Things to Consider

Understanding of the Disease Process

Footcare Knowledge

Compliance History

Complexity of the Treatment or Therapy

Beliefs and Perceptions of Benefits

Family Support

Practitioner Reinforcement

Custom Shoe

Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial

bull 171 neuropathic diabetic patients with recently healed plantar foot ulcer

bull Custom-made footwear

bull Recurrence at 18 months

42

Diabetes Care 2013 Dec36(12)4109-16Bus SA1 Waaijman R Arts M de Haart M Busch-Westbroek T van Baal J Nollet F

Three Deforming Forces

bull Shearingbull May control with accomodative insoles orthotics and

AFO

bull Bending bull Seen with Equinus

bull May address with heel lift (1 inch)

bull Vertical Load

Preventing Recurrance Things to Consider

Understanding of the Disease Process

Footcare Knowledge

Compliance History

Complexity of the Treatment or Therapy

Beliefs and Perceptions of Benefits

Family Support

Practitioner Reinforcement

Custom Shoe

Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial

bull 171 neuropathic diabetic patients with recently healed plantar foot ulcer

bull Custom-made footwear

bull Recurrence at 18 months

42

Diabetes Care 2013 Dec36(12)4109-16Bus SA1 Waaijman R Arts M de Haart M Busch-Westbroek T van Baal J Nollet F

Preventing Recurrance Things to Consider

Understanding of the Disease Process

Footcare Knowledge

Compliance History

Complexity of the Treatment or Therapy

Beliefs and Perceptions of Benefits

Family Support

Practitioner Reinforcement

Custom Shoe

Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial

bull 171 neuropathic diabetic patients with recently healed plantar foot ulcer

bull Custom-made footwear

bull Recurrence at 18 months

42

Diabetes Care 2013 Dec36(12)4109-16Bus SA1 Waaijman R Arts M de Haart M Busch-Westbroek T van Baal J Nollet F

Custom Shoe

Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial

bull 171 neuropathic diabetic patients with recently healed plantar foot ulcer

bull Custom-made footwear

bull Recurrence at 18 months

42

Diabetes Care 2013 Dec36(12)4109-16Bus SA1 Waaijman R Arts M de Haart M Busch-Westbroek T van Baal J Nollet F

Effect of custom-made footwear on foot ulcer recurrence in diabetes a multicenter randomized controlled trial

bull 171 neuropathic diabetic patients with recently healed plantar foot ulcer

bull Custom-made footwear

bull Recurrence at 18 months

42

Diabetes Care 2013 Dec36(12)4109-16Bus SA1 Waaijman R Arts M de Haart M Busch-Westbroek T van Baal J Nollet F

AFO

AFO

bull Reduces stress to foot and ankle

bull 72-90 more reduction of peak pressure to ulcer sites versus shoes with Plastizote liners

bull Limit mobility in all 3 planes of rearfoot and midfoot

bull Light weight inconspicuous

bull Cant adapt to deformity at foot level

bull Hard plastic

bull Not much help with equinus

Double Upright Brace

Double Upright Brace

bull Similar to AFO but brace is fixed to heel of shoe

bull Still need work inside shoe to accommodate foot deformity

bull Combining 1-inch heel raise and a rocker sole may help to reduce bending forces within the foot during gait

bull This combo disperses mechanical stress

bull Articulation either locked at neutral or

only allows plantarflexion

Double Upright Patellar Bearing Brace

bull More restrictive

bull More difficult to fit

bull Attempts to direct vertical WB forces through the knee

bull More effective at reducing load to the rearfoot

bull Can combine with extra depth custom molded shoes

CROW

CROW

bull Charcot Restraint Orthotic Walker

bull Fuly enclosed AFO with rocker bottom

bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole

bull Attempts to distribute pressure evenly throughout foot and leg

bull Unevenbull Fall riskbull Good fit

TORCH Walker

TORCH Walker

bull Total contact Orthotic Restraining Custom Hybrid

bull Custom Insert

bull Rocker Bottom

bull Integrated solid AFO

bull Adjustable for edema

Ambulatory AidesOften Forgotten Addition to Offloading Devices

bull Cane - Increases base of support No off-loading

bull Crutches - NWB to PWBbull REALISTICbull SAFE

bull Walker - Greater stability NWB to PWB

bull Wheel Chair

A stretching program can significantly reduce peak plantar pressures in diabetic subjects

Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002

The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus

Gait Alterations in Diabetes

bull Individuals with diabetes

bull slower

bull shorter step lengths

bull longer stance phase

bull wider base of support

bull greater step time variability on irregular surfaces

bull improper pressure distribution

bull decreased ankle mobility ankle moment and ankle power during walking

Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait

Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash

1374

Gait Modifications We Can Teach to Reduce Plantar Pressures

Lengthen stride

Faster cadence

Alter foot placement

More Propulsive

Hip strategyDiabetic gait With improved

stride length

Smart Sox

bull Socks with fiber-optics that can measure temperature pressure

bull Communicate that information via bluetooth or wifi to smart phone or doctor

bull ldquoPrescribe activityrdquo

Closing Remarks Thank You

References

bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31

bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf

References

bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS

bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135

bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57

AFO

bull Reduces stress to foot and ankle

bull 72-90 more reduction of peak pressure to ulcer sites versus shoes with Plastizote liners

bull Limit mobility in all 3 planes of rearfoot and midfoot

bull Light weight inconspicuous

bull Cant adapt to deformity at foot level

bull Hard plastic

bull Not much help with equinus

Double Upright Brace

Double Upright Brace

bull Similar to AFO but brace is fixed to heel of shoe

bull Still need work inside shoe to accommodate foot deformity

bull Combining 1-inch heel raise and a rocker sole may help to reduce bending forces within the foot during gait

bull This combo disperses mechanical stress

bull Articulation either locked at neutral or

only allows plantarflexion

Double Upright Patellar Bearing Brace

bull More restrictive

bull More difficult to fit

bull Attempts to direct vertical WB forces through the knee

bull More effective at reducing load to the rearfoot

bull Can combine with extra depth custom molded shoes

CROW

CROW

bull Charcot Restraint Orthotic Walker

bull Fuly enclosed AFO with rocker bottom

bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole

bull Attempts to distribute pressure evenly throughout foot and leg

bull Unevenbull Fall riskbull Good fit

TORCH Walker

TORCH Walker

bull Total contact Orthotic Restraining Custom Hybrid

bull Custom Insert

bull Rocker Bottom

bull Integrated solid AFO

bull Adjustable for edema

Ambulatory AidesOften Forgotten Addition to Offloading Devices

bull Cane - Increases base of support No off-loading

bull Crutches - NWB to PWBbull REALISTICbull SAFE

bull Walker - Greater stability NWB to PWB

bull Wheel Chair

A stretching program can significantly reduce peak plantar pressures in diabetic subjects

Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002

The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus

Gait Alterations in Diabetes

bull Individuals with diabetes

bull slower

bull shorter step lengths

bull longer stance phase

bull wider base of support

bull greater step time variability on irregular surfaces

bull improper pressure distribution

bull decreased ankle mobility ankle moment and ankle power during walking

Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait

Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash

1374

Gait Modifications We Can Teach to Reduce Plantar Pressures

Lengthen stride

Faster cadence

Alter foot placement

More Propulsive

Hip strategyDiabetic gait With improved

stride length

Smart Sox

bull Socks with fiber-optics that can measure temperature pressure

bull Communicate that information via bluetooth or wifi to smart phone or doctor

bull ldquoPrescribe activityrdquo

Closing Remarks Thank You

References

bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31

bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf

References

bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS

bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135

bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57

Double Upright Brace

Double Upright Brace

bull Similar to AFO but brace is fixed to heel of shoe

bull Still need work inside shoe to accommodate foot deformity

bull Combining 1-inch heel raise and a rocker sole may help to reduce bending forces within the foot during gait

bull This combo disperses mechanical stress

bull Articulation either locked at neutral or

only allows plantarflexion

Double Upright Patellar Bearing Brace

bull More restrictive

bull More difficult to fit

bull Attempts to direct vertical WB forces through the knee

bull More effective at reducing load to the rearfoot

bull Can combine with extra depth custom molded shoes

CROW

CROW

bull Charcot Restraint Orthotic Walker

bull Fuly enclosed AFO with rocker bottom

bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole

bull Attempts to distribute pressure evenly throughout foot and leg

bull Unevenbull Fall riskbull Good fit

TORCH Walker

TORCH Walker

bull Total contact Orthotic Restraining Custom Hybrid

bull Custom Insert

bull Rocker Bottom

bull Integrated solid AFO

bull Adjustable for edema

Ambulatory AidesOften Forgotten Addition to Offloading Devices

bull Cane - Increases base of support No off-loading

bull Crutches - NWB to PWBbull REALISTICbull SAFE

bull Walker - Greater stability NWB to PWB

bull Wheel Chair

A stretching program can significantly reduce peak plantar pressures in diabetic subjects

Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002

The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus

Gait Alterations in Diabetes

bull Individuals with diabetes

bull slower

bull shorter step lengths

bull longer stance phase

bull wider base of support

bull greater step time variability on irregular surfaces

bull improper pressure distribution

bull decreased ankle mobility ankle moment and ankle power during walking

Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait

Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash

1374

Gait Modifications We Can Teach to Reduce Plantar Pressures

Lengthen stride

Faster cadence

Alter foot placement

More Propulsive

Hip strategyDiabetic gait With improved

stride length

Smart Sox

bull Socks with fiber-optics that can measure temperature pressure

bull Communicate that information via bluetooth or wifi to smart phone or doctor

bull ldquoPrescribe activityrdquo

Closing Remarks Thank You

References

bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31

bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf

References

bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS

bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135

bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57

Double Upright Brace

bull Similar to AFO but brace is fixed to heel of shoe

bull Still need work inside shoe to accommodate foot deformity

bull Combining 1-inch heel raise and a rocker sole may help to reduce bending forces within the foot during gait

bull This combo disperses mechanical stress

bull Articulation either locked at neutral or

only allows plantarflexion

Double Upright Patellar Bearing Brace

bull More restrictive

bull More difficult to fit

bull Attempts to direct vertical WB forces through the knee

bull More effective at reducing load to the rearfoot

bull Can combine with extra depth custom molded shoes

CROW

CROW

bull Charcot Restraint Orthotic Walker

bull Fuly enclosed AFO with rocker bottom

bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole

bull Attempts to distribute pressure evenly throughout foot and leg

bull Unevenbull Fall riskbull Good fit

TORCH Walker

TORCH Walker

bull Total contact Orthotic Restraining Custom Hybrid

bull Custom Insert

bull Rocker Bottom

bull Integrated solid AFO

bull Adjustable for edema

Ambulatory AidesOften Forgotten Addition to Offloading Devices

bull Cane - Increases base of support No off-loading

bull Crutches - NWB to PWBbull REALISTICbull SAFE

bull Walker - Greater stability NWB to PWB

bull Wheel Chair

A stretching program can significantly reduce peak plantar pressures in diabetic subjects

Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002

The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus

Gait Alterations in Diabetes

bull Individuals with diabetes

bull slower

bull shorter step lengths

bull longer stance phase

bull wider base of support

bull greater step time variability on irregular surfaces

bull improper pressure distribution

bull decreased ankle mobility ankle moment and ankle power during walking

Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait

Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash

1374

Gait Modifications We Can Teach to Reduce Plantar Pressures

Lengthen stride

Faster cadence

Alter foot placement

More Propulsive

Hip strategyDiabetic gait With improved

stride length

Smart Sox

bull Socks with fiber-optics that can measure temperature pressure

bull Communicate that information via bluetooth or wifi to smart phone or doctor

bull ldquoPrescribe activityrdquo

Closing Remarks Thank You

References

bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31

bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf

References

bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS

bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135

bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57

Double Upright Patellar Bearing Brace

bull More restrictive

bull More difficult to fit

bull Attempts to direct vertical WB forces through the knee

bull More effective at reducing load to the rearfoot

bull Can combine with extra depth custom molded shoes

CROW

CROW

bull Charcot Restraint Orthotic Walker

bull Fuly enclosed AFO with rocker bottom

bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole

bull Attempts to distribute pressure evenly throughout foot and leg

bull Unevenbull Fall riskbull Good fit

TORCH Walker

TORCH Walker

bull Total contact Orthotic Restraining Custom Hybrid

bull Custom Insert

bull Rocker Bottom

bull Integrated solid AFO

bull Adjustable for edema

Ambulatory AidesOften Forgotten Addition to Offloading Devices

bull Cane - Increases base of support No off-loading

bull Crutches - NWB to PWBbull REALISTICbull SAFE

bull Walker - Greater stability NWB to PWB

bull Wheel Chair

A stretching program can significantly reduce peak plantar pressures in diabetic subjects

Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002

The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus

Gait Alterations in Diabetes

bull Individuals with diabetes

bull slower

bull shorter step lengths

bull longer stance phase

bull wider base of support

bull greater step time variability on irregular surfaces

bull improper pressure distribution

bull decreased ankle mobility ankle moment and ankle power during walking

Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait

Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash

1374

Gait Modifications We Can Teach to Reduce Plantar Pressures

Lengthen stride

Faster cadence

Alter foot placement

More Propulsive

Hip strategyDiabetic gait With improved

stride length

Smart Sox

bull Socks with fiber-optics that can measure temperature pressure

bull Communicate that information via bluetooth or wifi to smart phone or doctor

bull ldquoPrescribe activityrdquo

Closing Remarks Thank You

References

bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31

bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf

References

bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS

bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135

bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57

CROW

CROW

bull Charcot Restraint Orthotic Walker

bull Fuly enclosed AFO with rocker bottom

bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole

bull Attempts to distribute pressure evenly throughout foot and leg

bull Unevenbull Fall riskbull Good fit

TORCH Walker

TORCH Walker

bull Total contact Orthotic Restraining Custom Hybrid

bull Custom Insert

bull Rocker Bottom

bull Integrated solid AFO

bull Adjustable for edema

Ambulatory AidesOften Forgotten Addition to Offloading Devices

bull Cane - Increases base of support No off-loading

bull Crutches - NWB to PWBbull REALISTICbull SAFE

bull Walker - Greater stability NWB to PWB

bull Wheel Chair

A stretching program can significantly reduce peak plantar pressures in diabetic subjects

Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002

The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus

Gait Alterations in Diabetes

bull Individuals with diabetes

bull slower

bull shorter step lengths

bull longer stance phase

bull wider base of support

bull greater step time variability on irregular surfaces

bull improper pressure distribution

bull decreased ankle mobility ankle moment and ankle power during walking

Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait

Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash

1374

Gait Modifications We Can Teach to Reduce Plantar Pressures

Lengthen stride

Faster cadence

Alter foot placement

More Propulsive

Hip strategyDiabetic gait With improved

stride length

Smart Sox

bull Socks with fiber-optics that can measure temperature pressure

bull Communicate that information via bluetooth or wifi to smart phone or doctor

bull ldquoPrescribe activityrdquo

Closing Remarks Thank You

References

bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31

bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf

References

bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS

bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135

bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57

CROW

bull Charcot Restraint Orthotic Walker

bull Fuly enclosed AFO with rocker bottom

bull 2 plastic or fiberglass clam shell pieces with custom removable foam insole

bull Attempts to distribute pressure evenly throughout foot and leg

bull Unevenbull Fall riskbull Good fit

TORCH Walker

TORCH Walker

bull Total contact Orthotic Restraining Custom Hybrid

bull Custom Insert

bull Rocker Bottom

bull Integrated solid AFO

bull Adjustable for edema

Ambulatory AidesOften Forgotten Addition to Offloading Devices

bull Cane - Increases base of support No off-loading

bull Crutches - NWB to PWBbull REALISTICbull SAFE

bull Walker - Greater stability NWB to PWB

bull Wheel Chair

A stretching program can significantly reduce peak plantar pressures in diabetic subjects

Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002

The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus

Gait Alterations in Diabetes

bull Individuals with diabetes

bull slower

bull shorter step lengths

bull longer stance phase

bull wider base of support

bull greater step time variability on irregular surfaces

bull improper pressure distribution

bull decreased ankle mobility ankle moment and ankle power during walking

Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait

Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash

1374

Gait Modifications We Can Teach to Reduce Plantar Pressures

Lengthen stride

Faster cadence

Alter foot placement

More Propulsive

Hip strategyDiabetic gait With improved

stride length

Smart Sox

bull Socks with fiber-optics that can measure temperature pressure

bull Communicate that information via bluetooth or wifi to smart phone or doctor

bull ldquoPrescribe activityrdquo

Closing Remarks Thank You

References

bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31

bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf

References

bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS

bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135

bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57

TORCH Walker

TORCH Walker

bull Total contact Orthotic Restraining Custom Hybrid

bull Custom Insert

bull Rocker Bottom

bull Integrated solid AFO

bull Adjustable for edema

Ambulatory AidesOften Forgotten Addition to Offloading Devices

bull Cane - Increases base of support No off-loading

bull Crutches - NWB to PWBbull REALISTICbull SAFE

bull Walker - Greater stability NWB to PWB

bull Wheel Chair

A stretching program can significantly reduce peak plantar pressures in diabetic subjects

Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002

The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus

Gait Alterations in Diabetes

bull Individuals with diabetes

bull slower

bull shorter step lengths

bull longer stance phase

bull wider base of support

bull greater step time variability on irregular surfaces

bull improper pressure distribution

bull decreased ankle mobility ankle moment and ankle power during walking

Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait

Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash

1374

Gait Modifications We Can Teach to Reduce Plantar Pressures

Lengthen stride

Faster cadence

Alter foot placement

More Propulsive

Hip strategyDiabetic gait With improved

stride length

Smart Sox

bull Socks with fiber-optics that can measure temperature pressure

bull Communicate that information via bluetooth or wifi to smart phone or doctor

bull ldquoPrescribe activityrdquo

Closing Remarks Thank You

References

bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31

bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf

References

bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS

bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135

bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57

TORCH Walker

bull Total contact Orthotic Restraining Custom Hybrid

bull Custom Insert

bull Rocker Bottom

bull Integrated solid AFO

bull Adjustable for edema

Ambulatory AidesOften Forgotten Addition to Offloading Devices

bull Cane - Increases base of support No off-loading

bull Crutches - NWB to PWBbull REALISTICbull SAFE

bull Walker - Greater stability NWB to PWB

bull Wheel Chair

A stretching program can significantly reduce peak plantar pressures in diabetic subjects

Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002

The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus

Gait Alterations in Diabetes

bull Individuals with diabetes

bull slower

bull shorter step lengths

bull longer stance phase

bull wider base of support

bull greater step time variability on irregular surfaces

bull improper pressure distribution

bull decreased ankle mobility ankle moment and ankle power during walking

Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait

Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash

1374

Gait Modifications We Can Teach to Reduce Plantar Pressures

Lengthen stride

Faster cadence

Alter foot placement

More Propulsive

Hip strategyDiabetic gait With improved

stride length

Smart Sox

bull Socks with fiber-optics that can measure temperature pressure

bull Communicate that information via bluetooth or wifi to smart phone or doctor

bull ldquoPrescribe activityrdquo

Closing Remarks Thank You

References

bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31

bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf

References

bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS

bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135

bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57

Ambulatory AidesOften Forgotten Addition to Offloading Devices

bull Cane - Increases base of support No off-loading

bull Crutches - NWB to PWBbull REALISTICbull SAFE

bull Walker - Greater stability NWB to PWB

bull Wheel Chair

A stretching program can significantly reduce peak plantar pressures in diabetic subjects

Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002

The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus

Gait Alterations in Diabetes

bull Individuals with diabetes

bull slower

bull shorter step lengths

bull longer stance phase

bull wider base of support

bull greater step time variability on irregular surfaces

bull improper pressure distribution

bull decreased ankle mobility ankle moment and ankle power during walking

Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait

Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash

1374

Gait Modifications We Can Teach to Reduce Plantar Pressures

Lengthen stride

Faster cadence

Alter foot placement

More Propulsive

Hip strategyDiabetic gait With improved

stride length

Smart Sox

bull Socks with fiber-optics that can measure temperature pressure

bull Communicate that information via bluetooth or wifi to smart phone or doctor

bull ldquoPrescribe activityrdquo

Closing Remarks Thank You

References

bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31

bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf

References

bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS

bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135

bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57

A stretching program can significantly reduce peak plantar pressures in diabetic subjects

Goldsmith JR Lidtke RH Shott S JAPMA92(9) October 2002

The effects of range of motion therapy on the plantar pressures of patients with diabetes mellitus

Gait Alterations in Diabetes

bull Individuals with diabetes

bull slower

bull shorter step lengths

bull longer stance phase

bull wider base of support

bull greater step time variability on irregular surfaces

bull improper pressure distribution

bull decreased ankle mobility ankle moment and ankle power during walking

Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait

Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash

1374

Gait Modifications We Can Teach to Reduce Plantar Pressures

Lengthen stride

Faster cadence

Alter foot placement

More Propulsive

Hip strategyDiabetic gait With improved

stride length

Smart Sox

bull Socks with fiber-optics that can measure temperature pressure

bull Communicate that information via bluetooth or wifi to smart phone or doctor

bull ldquoPrescribe activityrdquo

Closing Remarks Thank You

References

bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31

bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf

References

bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS

bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135

bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57

Gait Alterations in Diabetes

bull Individuals with diabetes

bull slower

bull shorter step lengths

bull longer stance phase

bull wider base of support

bull greater step time variability on irregular surfaces

bull improper pressure distribution

bull decreased ankle mobility ankle moment and ankle power during walking

Brach JS Talkowski JB Strotmeyer ES Newman AB Diabetes Mellitus and Gait

Dysfunction Possible Explanatory Factors Phys Ther 2008 November 88(11) 1365ndash

1374

Gait Modifications We Can Teach to Reduce Plantar Pressures

Lengthen stride

Faster cadence

Alter foot placement

More Propulsive

Hip strategyDiabetic gait With improved

stride length

Smart Sox

bull Socks with fiber-optics that can measure temperature pressure

bull Communicate that information via bluetooth or wifi to smart phone or doctor

bull ldquoPrescribe activityrdquo

Closing Remarks Thank You

References

bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31

bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf

References

bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS

bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135

bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57

Gait Modifications We Can Teach to Reduce Plantar Pressures

Lengthen stride

Faster cadence

Alter foot placement

More Propulsive

Hip strategyDiabetic gait With improved

stride length

Smart Sox

bull Socks with fiber-optics that can measure temperature pressure

bull Communicate that information via bluetooth or wifi to smart phone or doctor

bull ldquoPrescribe activityrdquo

Closing Remarks Thank You

References

bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31

bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf

References

bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS

bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135

bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57

Smart Sox

bull Socks with fiber-optics that can measure temperature pressure

bull Communicate that information via bluetooth or wifi to smart phone or doctor

bull ldquoPrescribe activityrdquo

Closing Remarks Thank You

References

bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31

bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf

References

bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS

bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135

bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57

Closing Remarks Thank You

References

bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31

bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf

References

bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS

bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135

bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57

References

bull Saltzman CL Johnson KA Goldstein RH Donnelly RE The patellar tendon-bearing brace as treatment for neurotrophic arthropathy a dynamic force monitoring study Foot Ankle1992 13(1)14-31

bull Raikin SM Parks GBG Noll KH Schon LC Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot Foot Ankle Int 2001 22(3)214-219 -See more at httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-footsthashY5x2cYE7dpuf

References

bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS

bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135

bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57

References

bull Can Bracing Have An Impact For The Charcot FootPodiatry Today Feb 27 2013 httpwwwpodiatrytodaycomcan-bracing-have-impact-charcot-foot Alan Banks DPM FACFAS

bull Kitaoka HB Crevoisier XM Harbst K Hansen D Kotajarvi B Kaufman K The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces Arch PhysMed Rehabil 2006 87(1)130-135

bull Landsman AS Sage R Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis J Am Podiatr Med Assoc 1987 87(8)349-57