S O P - Footwear for WHO Grade 1 foot Disability

Protective footwear should be worn by patients with sole sensory loss, whether or not
they have sole wounds, throughout their lifetime. MCR cushioned insole will distribute
walking pressure more widely over the sole and thus minimize the risk of wounds at
pressure sites.

Version Number: 5
Effective Date: 1st June, 2009
Review date: 14th June 2010 (1st review), 30thJune 2011 (2nd review); 23/09/2014 (3rd
review), 15th July 2016, (4th review), 20th Dec 2017 (5th review)
Author/Position: Kameshwar Rao, Physio Coordinator
Name of SOP: Protective Footwear for the persons affected by leprosy with WHO Grade
1 foot disability.
Purpose: Providing Micro Cellular Rubber (MCR) footwear to the persons affected by
leprosy with anesthestic foot.
Users: Physio-technicians and shoe technicians
Relevance to Organizational Strategy: Direct service delivery
Relevance to National Programme: DPMR guidelines
Reference:
 Simple Appliances for Feet that can’t Feel - Hugh C
 “I can do it myself” Tips for people affected by Leprosy who want to prevent
disability-WHO- Dr. Hugh Cross
 Notes on Podiatry, skin and ulcer care ………….Justin Bolton
 Essential Action to Minimise Disability in Leprosy patients and Preventing
Disability in Leprosy Patients” – Jean Watson
 Central Footwear Training Institute, Agra

Process:
1. Definition

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 A process of assessing the loss of protective sensation of the foot and providing MCR
footwear
2. Procedure
Procedure Person (s)
Responsible
Foot sensory examination Physio
- Using ball-point pen or 10gm orange mono filament (nylon) technician or
- Touch normal skin to determine the level of normal sensitivity. Trained staff.
Touch a site once only. Do not stroke. Compare sensation in
normal skin to that in a sole. Ask the person to touch the place
you touch, accurately, with the tip of a finger.
- When he/she can do this ask him/her to shut his eyes and
continue to test with light pressure (which is protective
sensation) on 5 pressure sites of sole of the foot. (big toe;
forefoot; lateral; heel)
- If does not feel sensation on any two of the sites, consider as
anesthetic foot.
- Also look for burns, cuts, cracks, injury, scars, loss of digits.
- Decide for the footwear option
Footwear measurements Shoe
- Always take measurement while person on standing position. technician
- Use standardized format (Annexure) developed by the technical
team for foot mapping and measurements recording.
- Determine the size of the footwear.
Making Footwear Shoe
- Always keep different sizes of model LAST for proper fitting technician
and each component of a shoe make on a LAST to ensure
suitable size and proper fitness.
- Use adjustable upper straps with back strap or heel cover.
- Use 10mm MCR with 20+shore insole and 6mm flat flexible
out sole, soft thin lining leather, milk solution and Velcro
- Avoid usage of metal items (buckles, rivets etc.,)
- Consult the user for color straps and design while making
footwear.
Education on footwear and foot care Physio-
- Check the feet every day for any injury because of footwear technician and
usage Shoe

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 - Not to walk far distance locations and not run technician
- Make habit of short steps while walking
- About footwear proper maintenance
Periodical Follow-up Physio-
- Regular monitoring the users at least once in 3 months for technician
persons usage practice, consultation, footwear durability and
damage
Documentation Physio-
- Update case sheets ( include user comments) technician
- Footwear stock entry/indent register
- Footwear issue/acquaintance register
- Execute study questionnaires

2. Training requirements (Wherever applicable)

 Periodic orientation on new techniques of shoe making, study on footwear
users’ perception, models, new materials, durability, cost etc.,
3. Indicator
a) Process indicator - No. of people received footwear
- No of people being used regularly
b) Outcome indicator
- No. of people not developed injuries/ulcer after footwear use.

Signature of Assessor:
Mr Kameshwar Rao, Physio Coordinator
Mr. Sathiraju, State Coordinator
Mr. Rajnikant Sing, State Coordinator

Date: 5th January 2018

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