C07: Footwear, Orthotics & Biomechanics (prevention)

A diabetic foot ulcer forms where repetitive stress meets soft tissue over a bony prominence in a foot that can no longer feel it. Once healed, an ulcer recurs in roughly 42% of people within one year and 65% within five. Prevention is therefore a mechanical problem: find where load concentrates, understand why, and redistribute or reduce it with a device the patient will actually wear.

The module explains how neuropathy, glycation, fat-pad change, gait and deformity concentrate load, and why shear means a normal pressure map never fully excludes risk. It appraises the Bus 2013 trial, in which custom footwear reduced recurrence only in patients wearing it for at least 80% of steps, and the design-feature evidence, in which pressure-informed insole modification gave the largest reduction in peak pressure. It covers custom versus prefabricated devices, objective adherence data, foot-ankle exercise and the ceiling of footwear in the Charcot midfoot. C04 covers the day-to-day prescription and its review; C07 is the biomechanics and evidence beneath it.

Content is tiered at Foundation, Core and Advanced level, with two algorithms and three case vignettes. You receive the Teaching Document, the Evidence Base, the slide deck and a narrated video.