Orthotic and Prosthetic Options after Diabetic Foot Amputation

Abstract

Diabetic foot ulcer is a risk factor for amputation. Infection and ischemia in diabetic foot ulcers are common causes of foot amputation. After minimal amputation of the involved lower extremity, precise and cautious application of orthoses and prostheses is very important to recover function of the foot. In this context, several factors including the patient’s general condition, level of amputation, preoperative ability of gait, contracture of adjacent joints, and wound healing potential must be considered. Most orthoses for diabetic foot amputees are used as an off-loading strategy to relieve pressure from the foot and ankle. Total contact cast is the standard treatment for forefoot off-loading. Footwear and insole design orthoses for off-loading in diabetic foot amputees have a low level of evidence and controversial effectiveness. Removable pressure-relieving ankle foot orthoses can be used as an alternative to total contact casts in selective situations. Metatarsal pads can be used effectively to decrease plantar pressure at a low cost. Prostheses after lower extremity amputation must be used with caution for rehabilitation factors due to sustained wound problems and change of stump size.