Name of the Procedure:

• Common Name(s): Custom Diabetic Shoe Insert, Heat-Molded Insert
• Technical/Medical Term: Multiple Density Insert, Direct Formed, Molded to Foot After External Heat Source

Summary

This procedure involves creating a custom-molded shoe insert for diabetic patients. The insert is made by heating a special material to at least 230 degrees Fahrenheit and then molding it to the patient's foot to ensure a perfect fit and total contact with the foot's arch and base layer.

Purpose

Medical Conditions Addressed

• Diabetic foot ulcers
• Foot deformities
• Pressure sores

Goals or Outcomes

• Redistribute pressure across the foot
• Reduce the risk of foot ulcers
• Enhance walking comfort and stability

Indications

Symptoms/Conditions

• History of diabetic foot ulcers
• Areas of high pressure on the foot
• Poorly fitting shoes causing discomfort

Patient Criteria

• Diagnosed diabetes mellitus
• Patients with loss of protective sensation
• Patients with foot deformities requiring customized support

Preparation

Pre-Procedure Instructions

• Clean and dry feet thoroughly
• Wear loose-fitting shoes on the day of the molding

Diagnostic Tests

• Foot pressure mapping
• Visual foot inspection for sores or ulcers

Procedure Description

1. Heating the Insert: The insert material is heated to at least 230 degrees Fahrenheit.
2. Foot Preparation: The patient's foot is positioned and prepared for molding.
3. Molding: The heated insert is placed on the foot and molded to the exact contours, ensuring full contact with the arch and base.

4. Cooling and Hardening: The insert cools to maintain its shape.

   Tools/Equipment Used

   • Heat source (e.g., oven)
   • Molding materials with Shore A 35 durometer

Anesthesia/Sedation

• Generally not required

Duration

• Typically takes around 30 minutes

Setting

• Outpatient clinic
• Podiatrist’s office

Personnel

• Podiatrist
• Orthotist or certified technician

Risks and Complications

Common Risks

• Minor discomfort during molding
• Initial adjustment period for the foot to get used to the insert

Rare Risks

• Burns from improper heating
• Allergic reactions to materials

Benefits

• Immediate relief from pressure points
• Custom fit providing enhanced comfort
• Reduced risk of developing foot ulcers

Recovery

Post-Procedure Care

• Gradually break in the new insert by wearing it for short periods
• Monitor for any signs of irritation or redness

Expected Recovery Time

• Most patients adjust within a week
• Follow-up appointments to check fit and effectiveness

Alternatives

Other Options

• Off-the-shelf orthotic inserts
• Shoes with built-in arch support

Pros and Cons

• Custom inserts offer a superior fit and more effective pressure redistribution compared to off-the-shelf options.

Patient Experience

During the Procedure

• The patient may feel slight warmth and pressure as the insert molds to their foot.

After the Procedure

• Initial adjustment period with some discomfort is possible
• Pain management typically involves over-the-counter pain relievers if necessary

With the proper care and usage, the custom-molded inserts can significantly enhance foot health and comfort for diabetic patients.