Paul Charlton Speaks at the Vascular Annual Scientific Meeting


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  • Paul Charlton

Paul Charlton, senior orthotist at Peacocks Medical Group, recently spoke at the Vascular Society Annual Scientific Meeting and discussed interventions to promote healing and preventing recurrent diabetic foot ulcers. 


Paul explored the role of an orthotist in treating patients with diabetes.   


Treatment options 

When treating diabetic foot ulcers orthotists need to be able to work with patients to limit, or prevent pressure, to at-risk areas. This includes offloading plantar areas and, where possible, the whole of the foot. Mobility is also encouraged to help keep patients as physically fit as possible. 

Paul advised that, wherever possible, orthotists try to keep patients in their own footwear by offering advice on footwear selection such as insoles that could go in to their shoes and access to technicians who can modify patients’ own shoes when appropriate. 


However, unless the patient’s footwear is anchored accordingly, the challenge with footwear and providing sufficient room for width, is the risk of sliding within the shoe. It is, therefore, important that footwear is secured with a lace or velcro. The role of the orthotist is to accommodate a potentially very mobile foot.  


Ready-made extra depth and made-to-measure footwear, is another option that ensures the foot is anchored well and friction is minimised. From an aesthetic perspective, the styles of footwear vary in appearance from modern trainers to custom-built slippers, worn in the comfort of the patient’s home. 


Paul then explained that research remains ongoing when it comes to understanding pressure threshold that will prevent plantar tissue damage from occurring. Redistributing weight reduces plantar pressure and trying to offload problem areas to less risk areas can help protect vulnerable tissues. 


Rocker soles and rigid inserts help to alleviate the foot having to bend, minimising impact. Beyond footwear and for patients who may be on bed rest, pressure relieving devices which unload the heel and prevent tightness in the calves are advised.  Tight calves have a big impact on plantar pressure. For longer term treatment a Total Contact Cast can be used to treat the ulcers fitting around the lower leg and foot, to a person’s individual requirements. 


Removable and non-removable cast walkers can be offered depending on the specific needs of the patient. A bohler walker is another option, with the foot suspended through the device to minimise weight going through the foot itself, clinically proven to offload 80% of the plantar surface of the foot.


Prescription options for a patient with a partial foot amputation were also discussed to optimise both cosmesis and mobility. Other orthotic options to help balance, foot-drop and mobility were also explored. 



Paul concluded that orthotists need to work alongside podiatrists as part of an integrated team - offering and sharing patient advice.  


Access to technology in routine clinical services to monitor pressures and effectiveness of offloading would advance benefits to patients. Undoubtedly timely orthotic intervention can greatly reduce problems and improve patients' lives.