title: Orthotic management of the neuropathic foot: an interdisciplinary care perspective.
abstract: BACKGROUND
  Clinical management of the patient with neuropathic foot is becoming commonplace in orthotic clinics worldwide. The presentations that can result from neuropathic foot are diverse, requiring clinicians to understand the pathomechanics of ulceration, infection, and Charcot joint arthropathy to provide effective interventions.
  
  
  OBJECTIVE
  The purpose of this clinical perspective is to provide a review of the literature regarding clinical concepts associated with orthotic management of neuropathic foot.
  
  
  METHODS
  Literature review and clinical case study.
  
  
  METHODS
  Relevant literature were reviewed and summarized, and a clinical case study synthesizing reviewed concepts was presented.
  
  
  RESULTS
  Given the multifactorial nature of the neuropathic foot, treatments must be multifaceted and patient-specific to effectively address the underlying disease processes. While systemic issues such as peripheral arterial disease are treated by physicians, local issues such as foot deformity are managed by orthotists. Orthotic interventions commonly include custom footwear to reduce the risk of ulceration through creation of a protective environment or targeted plantar offloading. Patient and caregiver education to encourage management compliance is equally as important to ensure successful treatment.
  
  
  CONCLUSIONS
  Patients with neuropathic foot benefit from an interdisciplinary care approach which engages physicians, wound care practitioners, and orthotists to treat and manage systemic and local problems. Addressing this pathology through interdisciplinary care may positively affect the patient's health status while lowering associated healthcare costs through improved treatment efficacy.
  
  
  CONCLUSIONS
  The commonality of neuropathic foot and associated complications including ulceration, infection, and Charcot joint arthropathy requires that the patient care team have a fundamental understanding of these pathologies and common treatment modalities. We review orthotic treatment modalities to assist clinicians with the management of patients with neuropathic foot.
authors.affiliation: Jesse Brown VA Medical Center, Northwestern University, Chicago, IL, USA c-robinson@northwestern.edu.
authors.forename: Christopher
authors.initials: C
authors.lastname: Robinson
authors.affiliation: Jesse Brown VA Medical Center, Northwestern University, Chicago, IL, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Major
authors.affiliation: Arise Orthotics & Prosthetics, Inc., Blaine, MN, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Kuffel
authors.affiliation: Arise Orthotics & Prosthetics, Inc., Blaine, MN, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Hines
authors.affiliation: Methodist Hospital Wound Clinic, St. Louis Park, MN, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Cole
mesh_terms: D001177:Arthropathy, Neurogenic / Q000453:epidemiology / Q000517:prevention & control; D017719:Diabetic Foot / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D019468:Disease Management; D005534:Foot Diseases / Q000453:epidemiology / Q000517:prevention & control; D061826:Foot Orthoses; D006801:Humans; D010348:Patient Care Team; D012307:Risk Factors
keywords: The diabetic foot; diabetes; lower limb orthotics; orthotics; skin; wound management