Posted June 22, 2017
Lower extremity orthopedic anomalies may be missed in patients diagnosed with diabetic or non-diabetic peripheral neuropathies. Because of a lack of normal sensation, it is often difficult for the patient to feel pain associated with the misalignment or dysfunction of the foot and ankle complex. This undetected repetitive micro trauma can cause breakdown of the boney structures and the surrounding soft tissues. Often, the patient first notices that something is wrong only after they have already developed a callus, blister or foot ulcer.
Diabetic foot ulcers (DFU) develop due to multiple causes. Most common is the repetitive striking or stress of the foot against the ground secondary to an orthopedic anomaly. For example, posterior tibialis dysfunction can lead to wounds on the medial aspect of the affected foot. Likewise, equinovarus deformity is associated with lateral forefoot, midfoot, or heel wounds. Often the DFU may be associated with inadequate footwear, however the lack of orthotic intervention may be a more compelling issue to address. Because so many in this patient population present with an underlying orthopedic anomaly, an orthotist or pedorthotist should be consulted immediately and included in the interdisciplinary medical management team. By involving the orthotic professional, an effective orthotic treatment program can be designed to enhance the wound treatment program. A custom orthosis can help to advance wound healing by properly aligning, correcting and stabilizing the limb while also allowing for maximum load bearing relief at the wound site.
The OWLS technology was designed to correct the orthopedic anomalies that would or have caused a wound in the neuopathic foot. The WHO (Wound Healing Orthosis) has three basic designs. These include: (1) WHO-Heel Relief, (2) WHO-Midfoot/Walking AFO, and (3) WHO-Forefoot designs. These three designs are only the starting point for the treatment of these orthopedic conditions and wounds. Ongoing clinical follow-up involves frequent reassessment of the affected limb, frequent adjustment of the custom orthosis to enhance fit and function, and ongoing orthotic consultation and management. Each patient is unique in his or her orthotic needs and a custom orthosis is required to optimize treatment outcomes.
See the various OWLS designs used to treat patients with peripheral neuropathies with associated deformities to help heal and/or prevent wound development here.
For more detailed clinical training in the OWLS program, please register for one of Orthomerica’s live seminars here.
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