Diabetic foot risk classification and shoe recommendations: lessons from SALSA at Rancho Los Amigos @RanchoRehab @KeckMedUSC

Ramya Tadinada, Charles DuBourdieu, Tanzim Khan and David G Armstrong

The goal of this article is to create an updated guideline on footwear for people with diabetes that is accessible for interdisciplinary healthcare professionals involved in managing people with diabetes. The authors reviewed several footwear publications, including national and international guidelines, expert consensus documents and clinical knowledge in order to formulate updated recommendations. They recommend healthcare professionals managing people with diabetes should counsel their patients to wear shoe gear that fits, protects and accommodates the shape of their feet. They emphasise that appropriate shoe prescriptions depend largely on the patient’s level of risk for diabetic foot ulceration or amputation. In the current Foot Risk Classification System, a risk- and treatment-based approach has been advocated that divides risks with appropriate prescription orders. They confine our recommendations regarding shoe prescriptions to patients in Categories 0–3: Category 0 include patients who are not likely to ulcerate; Category 1 include patients who have complete loss or have diminished protective sensation; Category 2 include patients with loss of protective sensation and presence of deformity with or without peripheral arterial disease

(PAD); Category 3 include patients who have a history of previous ulceration(s) and/ or amputation(s). Appropriate offloading devices can prevent and/or heal patients in respective categories. This guideline contains categories with respective offloading devices to protect and heal foot-related complications in patients with diabetes. It includes recommendations to guide healthcare professionals in selecting the most appropriate footwear to meet the specific needs for individuals with diabetes.

Citation: Tadinada R, DuBourdieu C, Khan T, Armstrong DG (2020) Diabetic foot risk classification and shoe recommendations: Lessons from SALSA at Rancho Los Amigos. The Diabetic Foot Journal 23(4): 64–9

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