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Friction Management

Friction Management to Reduce Ulceration Risk in Diabetic Patients

While pressure is an important contributor to ulcerations of the diabetic foot, shear forces (friction) also play a significant role. Hsi et al. noted that patients with areas of normal plantar pressure values may still ulcerate and patients with elevated plantar pressure may not.26   Lavery et al. said that foot pressure is a “poor tool” for predicting ulcers.27  He and others note that foot ulcers do not necessarily occur at sites of peak pressure but may occur at sites of normal pressure magnitudes.26,28

Orthotic modifications that control pressure (vertical forces) do not necessarily control shear (horizontal forces or forces parallel to the skin). To reduce shear (friction) the primary goal is to reduce the coefficient of friction (COF). The lower the COF, the less friction and the less load there will be on skin. The PTFE Patch™ which lowers the COF at localized areas prone to ulceration may be beneficial in reducing ulcer formation.

Orthotic Prescription Recommendation: Consider applying the PTFE Patch in areas at risk for ulceration. A study by Lavery compared rate of ulcer formation in patients using orthoses without PTFE and those using orthoses with PTFE and found orthoses with PTFE to be 3.5 times more effective at preventing ulcers.29

The PTFE Patch is a convenient and quick way to address friction in the clinic. A complete discussion of shear and the use of the PTFE Patch in the treatment and prevention of diabetic foot ulcers is available here.

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