Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Nov 15, 2022; 13(11): 912-920
Published online Nov 15, 2022. doi: 10.4239/wjd.v13.i11.912
Orthotic approach to prevention and management of diabetic foot: A narrative review
Min Cheol Chang, Yoo Jin Choo, In Sik Park, Myung Woo Park, Du Hwan Kim
Min Cheol Chang, Yoo Jin Choo, Rehabilitation Medicine, Yeungnam University, Daegu 42415, South Korea
In Sik Park, Korean Podiatry and Pedorthics Institute, Goyang 10442, South Korea
Myung Woo Park, Du Hwan Kim, Physical Medicine and Rehabilitation, Chung-Ang University, Seoul 06973, South Korea
Author contributions: Chang MC and Choo YJ consulted the literature and wrote the first draft, revised, and improved the manuscript; Chang MC, Choo YJ, Park IS, Park MW and Kim DH designed, checked, modified, and finalized the manuscript; and all authors have proofread the revised manuscript.
Supported by the National Research Foundation of Korea Grant that was funded by the Korean Government, No. NRF-2019M3E5D1A02069399.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Du Hwan Kim, MD, PhD, Associate Professor, Physical Medicine and Rehabilitation, Chung-Ang University, 102, Heukseok-ro, Dongjak-gu, Seoul 06973, South Korea.
Received: July 15, 2022
Peer-review started: July 15, 2022
First decision: August 7, 2022
Revised: August 24, 2022
Accepted: October 11, 2022
Article in press: October 11, 2022
Published online: November 15, 2022

Diabetic foot is a common complication affecting more than one-fifth of patients with diabetes. If not treated in time, it may lead to diabetic foot ulcers or Charcot arthropathy. For the management of diabetic foot, shoe modifications and orthoses can be used to reduce pressure on the affected foot or provide the foot with increased stability. In addition, the shoe modifications and orthotic devices can relieve patient discomfort during walking. Appropriate shoe modifications include changing the insole material, modifying the heel height, adding a steel shank or rocker sole, and using in-depth shoes. Alternatively, a walking brace or ankle-foot orthosis can be used to reduce the pressure on the affected foot. The purpose of this narrative review was to provide a reference guide to support clinicians in prescribing shoe modifications and foot orthoses to treat diabetic foot ulcers and Charcot arthropathy.

Keywords: Diabetic foot, Foot ulcers, Charcot arthropathy, Shoes, Foot orthosis

Core Tip: Footwear modifications and orthosis in diabetic foot management are aimed to prevent ulcers, protect the foot from external stimuli, and regulate the pressure on the foot. Types of shoe modifications include using an in-depth shoe, combination of insole materials, lifting the heel, applying a rocker sole, and applying an extended steel shank or flare or stabilizer. Orthosis includes prefabricated removable walking brace (such as control ankle motion walker, pneumatic walker, and conformer walking boot), Arizona ankle-foot orthosis, patellar-tendon-bearing orthosis, and Charcot restraint orthotic walker.