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Orthotic Apertures to Reduce Ulcers

Orthotic Apertures to Reduce Ulceration Risk in Diabetic Patients

Apertures can be a valuable orthotic modification to reduce local pressure that might lead to ulceration.

In a 2010 study, researchers evaluated bilateral 1st metatarsophalangeal joint (MPJ) aperture cutouts of semi-compressed felt padding. They found that an aperture for the first metatarsal head decreased peak pressure more effectively than the cushioning material alone.21 These apertures can be a very effective method for decreasing localized pressure under a metatarsal head. The potential problem with these apertures is that they will transfer pressure to adjacent areas of the foot and could increase risk of ulceration under an adjacent metatarsal head.22    

Orthotic Prescription Recommendation: Korex® and firm EVA are common materials used to add apertures to orthoses. To ensure proper placement of the aperture it is recommend that the patient first be allowed to wear the orthosis for approximately two weeks. During this time indentations will appear in the topcover indicating the location of higher pressures. Using these indentations as a template, apertures can then be added. For example, if an indentation is seen under the 3rd metatarsal head, 3mm Korex® can be applied to the bottom of the topcover under metatarsal heads 1, 2, 4 and 5, creating a slot aperture for the 3rd metatarsal head. Always provide patient education and regular evaluation of adjacent metatarsal heads when an aperture is used.

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