Skin/Soft Tissue Management of the Foot
Skin/Soft Tissue Management in the Compromised and at-Risk Foot
While skin/soft tissue management in the healthy foot is straightforward and relatively simple, in the compromised or at risk foot it becomes more complex. IPFH defines the “compromised” foot as one that has the beginnings of a systemic ailment or physical anomaly that causes concern for the long-term health of the foot. The “at-risk” foot is in even greater jeopardy, and is defined as being at immediate risk of ulceration, amputation or serious damage if physical and/or systemic issues are not addressed in an urgent manner.
The first step in effective skin/soft tissue management in either of these two types of feet involves assessment of both the long-term and the acute risk to the patient who has the threatening condition or symptoms. It is then useful to engage multiple practitioners in determining how best to manage the biomechanical and the skin/soft tissue aspects of the compromised or at-risk foot. The management team might include an orthopaedic surgeon, podiatrist (DPM), physical or rehabilitative medicine practitioner (physiatrist), orthotist, prosthetist, or certified pedorthist (C.Ped), as well as the patient’s primary care physician and medical specialists.
The concept of skin/soft tissue management has not yet been fully understood and recognized as a significant aspect of treatment in the fields of pedorthics, orthotics, podiatry, orthopaedics, and biomechanics. If it is important to manage the skin/soft tissue of the healthy foot, it is exponentially more important to manage it in the compromised or at-risk foot. This is especially true of the diabetic neuropathic foot, which is highly vulnerable because of its absence of protective sensation and (as is often the case) diminished or compromised circulation.
The integrated approach applies here, too: Select and fit padded socks with shoes that have non-slip outsoles, and include any inserts or orthotics prescribed or recommended by a doctor or foot health professional in the final fitting. Extra-depth shoes may be required if the patient needs custom-designed or special accommodative orthotics. Extra-depth shoes have extra height in the toe box and upper to allow for special inserts or orthotics and to accommodate foot deformities. If the patient’s feet have no significant shape anomalies, “off-the-shelf” depth shoes may be suitable. In situations where feet deviate from the normal shape as a result of pathologies, or have significant sizing issues, custom-molded accommodative or extra-depth shoes may be necessary.
Reviewed by Rachel Rader, DPM, IPFH Scientific Advisory Board
Last updated April 27, 2016
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