Prophylatic Mechanical Therapy in the Prevention of Neuropathic Ulcerations - Dissertation Example

An affective prophylactic measure therefore, assumes high priority in dealing with neuropathy and ulceration. Mechanical prophylactic methods namely special shoes, insoles, orthotic devices, gait patterns, canes and clutches aim to redistribute plantar pressure and have been used traditionally. However, the evidences supporting the affectivity of these methods are still rare. This literature review aims to make a critical analysis of the reported affectivity of mechanical prophylactic methods in preventing first incidence of ulceration in an individual with peripheral sensory neuropathy.

A thorough study of the literature available for the mechanical prophylactic devices was made using peer reviewed articles from academic journals and each of these was evaluated for its relevance to the specific condition being studied. It was found that of the wide variety of methods used, some have been reported to be highly affective, but for many others systematic studies are lacking. Further research is recommended for evaluating each of these mechanical prophylactic methods. {Key Words: Diabetic Ulcer, Neuropathy, Plantar Pressure, forefoot, Hindfoot, Offloading, orthotic devices, shoes, insoles, casts} Can the use of prophylactic mechanical therapy be beneficial in the prevention of neuropathic ulcerations I.

INTRODUCTION: Neuropathy, the general term for peripheral sensory neuropathy, is a disease involving functional impairment of the peripheral nervous system. The peripheral nervous system comprises of nerve roots, plexus, and autonomic, sensory & motors nerves connecting the various organs of the body to the central nervous system, i.e. the brain and spinal cord. A damage or dysfunction to one or more. The immediate cause of neuropathic root ulcerations being elevated plantar pressure, prophylactic measures aim to reduce the plantar pressure.

Mechanical methods are one of the most important among the several methods that have been recommended for prevention of the disease. These methods involve the use of various devices and means that ultimately aim to facilitate plantar pressure offloading of the vulnerable foot primarily by redistributing the foot load. Reports are available from many randomized control trials (RCTs) and prospective studies which provide the proof of various pressure reducing devices being effective in preventing foot ulcerations.

The major mechanical prophylactic methods reported for neuropathic foot ulcerations include use of padded hosiery, special shoes, Orthoses or special insoles and casts. Other than this gait alterations and bed rest are also recommended for off loading and thereby reducing pressure. Types of Mechanical Prophylactic Methods and their evidence of their efficacy in preventing neuropathic ulcerationsA. Hosiery: Padded hosiery (figure 4) is recommended for diabetic patients at risk of neuropathic ulcerations.

An early study describing the experimental use of padded hosiery was reported in 1989 (Veves et al., 653). The padded socks designed by an American hosiery manufacturer Thor-Lo, were made of acrylic (85%) and nylon (15%). Their claim that the socks reduce pressure on athlete’s feet was evaluated by Veves and colleagues.(Veves et al., 653).