What is an appropriate orthotic treatment for a diabetic patient at risk of neuropathic ulceration?

• A. Lightweight insoles only
• B. Full-contact cushioned orthosis in extra-depth shoes
• C. Standard running shoes
• D. A rigid arch support

Answer: (B)

For a diabetic patient at risk of neuropathic ulceration, the most appropriate orthotic treatment is a full-contact cushioned orthosis in extra-depth shoes. This option provides extensive support and pressure redistribution, essential for preventing ulceration in individuals with impaired sensation and circulation often associated with diabetes.

The cushioning helps to absorb impact and reduce stress on vulnerable areas of the foot, while the full-contact feature distributes weight more evenly across the foot, minimizing the risk of pressure points that could lead to ulceration. Extra-depth shoes accommodate the orthotic devices and provide additional space for any foot deformities common in diabetic patients, ensuring proper fit and comfort.

In contrast, lightweight insoles may provide some cushioning but often lack the structural support needed to adequately protect against ulceration. Standard running shoes may not be designed with the specific needs of diabetic patients in mind, particularly regarding pressure distribution and depth for any orthotic devices. Rigid arch supports, while providing stability, can increase pressure on certain areas of the foot without addressing the need for cushioning, potentially exacerbating the risk of ulcers. Thus, the comprehensive approach of full-contact cushioned orthoses in extra-depth shoes is optimum for minimizing the risk of neuropathic ulceration in these patients.