A good diabetic foot control program usually focuses on the prevention of diabetic foot, and two important preventive measures are health education and the use of sensible footwear. Unfortunately, it is only when diabetic patients have problems with their feet (such as the development of a diabetic ulcer) that they begin to seek health advice, something that often happens when these patients have never even had a peripheral nerve exam, or have not had one recently. Many of these patients are simply unaware of the dangers of diabetic neuropathy or its associated complications. For a patient who has never had a foot ulcer or experienced foot discomfort, it can be challenging to convince and limit the use of footwear (recommended by their health counselor). With a diabetic foot care team, this task becomes very efficient. Team members support each other, work collaboratively and are accountable when dealing with patients of common interest. Physicians and patients are the base members of the team, along with other ancillary staff (essential to a successful diabetic foot care team). Other members of the team include qualified diabetic education specialists, wound care nurses, physical therapists, podiatric shoe fabricators and brace orthotists who work with the physician and patient to prevent the occurrence of foot ulcers and amputations. The full-contact cast has been described as the gold standard for healing diabetic foot ulcers. It is important to note that podiatrists and orthotists play a fundamental role in the long-term care of healed ulcers and fractures and in preventing further ulcers and fractures. However, this approach is not ideal for the treatment of open ulcers and active Charcot’s fractures. Duties of a Podiatric Shoemaker A Podiatric Shoemaker is an artistic and scientific thinker who designs and makes appropriate and modified shoes and footbeds to relieve foot problems caused by disease, fatigue and trauma. A Podiatric Shoemaker fits and places footbeds, shoes and modified shoes according to the physician’s requirements. A podiatrist is educated in foot anatomy, pathology, shoe and footbed fabrication and use. In order to be certified by the Board, a Podiatric Shoemaker passes an examination and is accredited by the Orthopaedic College of Podiatry (BCP) and is bound by strict ethical regulations. The podiatric shoemaker plays a key role in the prevention of group ulcers and amputations, and his or her primary task is to provide patients with shoes that fit comfortably, including custom-made insoles that can be placed inside the shoe, or internal or external modifications to the shoe. The podiatrist not only installs and provides these products, but also adjusts and maintains them. Another role of the podiatrist is to educate patients on health issues, and is extremely important in teaching each patient how to make shoe choices, including basic requirements for comfort, instructions for use, and appropriate materials and types. As a member of the diabetic foot control team, he also reinforces the information and advice passed on by other team members. The Podiatry Shoe Fabricator also plays a part in monitoring the improvement of the patient’s condition, which is very useful for the physician to conduct follow-up visits and, if necessary, to remind other members to do so. The role of the brace orthotist The word orthosis is derived from the Greek word “ortho”, which means straight, upward or corrected, and the word “orthosis The word “orthosis” means to affect or change the structure or basic features of the nervous, muscular, or skeletal system through the use of an external device. The word scaffold and “orthosis” are often used interchangeably. However, “orthosis” is the more common term, and “orthotics” is often used to describe the theory, practice, construction, and modification of orthosis. Professionals in this field are called “orthotists”. To become an orthoticist, a person must pass a series of exams and be certified by one of two organizations: the American Orthotic and Prosthetic Association and the Orthotic and Prosthetic Fit Certification Board. Both certified podiatric shoe manufacturers and orthotic braces are required to undergo continuous, rigorous re-education and follow strict ethical guidelines from authorized organizations. The role of the brace orthotist is very similar to that of the podiatrist, educating the patient and monitoring progress. This is because shoes and optional braces are not only compatible with each other, but also complementary to each other. The orthotist and the podiatrist work very closely together. Sometimes the work of the orthotist and the podiatrist crosses over, but more often than not, they fill in the gaps. Podiatrists work primarily on the foot, while orthopedic braces provide orthopedic devices for the entire body. Podiatrists working in formal facilities have a certain number of therapeutic shoes and know who each product is intended for. Many orthopedic support facilities have a large number of skeletal orthoses. Shoes Inappropriate shoes have been shown to be a common cause of diabetic foot ulcers, and therapeutic shoes can significantly reduce the chances of ulcers developing. There are several functions that need to be achieved for diabetic therapeutic shoes, and it is important to be sure to gain insight into the following functions when discussing the different types of therapeutic shoes. They are: Protecting the foot: A foot that has lost sensation needs to be protected from external damage and various undesirable factors Reducing the area of excessive pressure: In daily life, certain areas of the foot are repeatedly subjected to high pressure that can lead to skin ulcers. These are generally the plantar process, such as the metatarsal head area, the callus area of the foot, hammertoe, and Haglund’s deformity. Reducing the pressure area so that the pressure is evenly distributed can reduce the incidence and recurrence of ulcers Reducing shock: Reducing pressure or shock in the vertical direction is important for patients with abnormalities in the bony prominence of the foot or bone structure, such as Charcot’s foot. Shear force reduction: Shear force is the force generated when the foot moves forward and backward within the shoe. Shear force reduction reduces callus formation, blistering and heat generation. Matching the deformity: Deformities usually arise from Charcot’s arthropathy, plantar fat pad atrophy, and amputation, and the shoes used should be well matched to the foot deformity. This is also important for forefoot deformities such as bunions, little toe capsulitis, hammertoes, and claw toes. Stabilization and support of deformities: Many deformities require stabilization and support, which can reduce pain and prevent further collapse of the foot structure and further progression of the deformity. Matching with foot orthotics or ankle orthotics: These orthotics may affect the comfort of the shoe and must take this into account. Not all shoes can be matched with these supports, and if metal orthotics are used on the outside of the shoe, the shoe must be modified to fit.