Richie Ulcer Guard with ShearBan Technology®
a New Approach to Managing Diabetic Foot Ulcerations

Douglas Richie, Jr., D.P.M.

Twenty years ago, I spent a great deal of time studying the effects of specialized therapeutic hosiery on patients with foot pathologies.  Early on, I became acutely aware of the damaging effects of shearing forces on the feet of patients with diabetes.  Since that time, I have searched for a modality which meets these criteria:

·        neutralizes shear loads;

·        works well with current pressure relief modalities;

·        can be instantly applied when trouble arises;

·        targets shear relief to the trouble spot; and

·        increases the potential for patient mobility.

Today, I believe I have found the solution in the form of a product known as ShearBan®.  This product has been used for over 10 years in the orthotics and prosthetics industry, primarily to prevent skin breakdown at the residual limb/prosthetic interface. I have reviewed the track record of this product, and it is impressive.  ShearBan® was developed by Marty Carlson, CPO, ME, and he has worked with me to modify this technology for easy application to therapeutic footwear and foot orthoses.  The product will be marketed under the name Richie Ulcer Guard with ShearBan Technology®.

Neutralizing Shear Forces

My own clinical testing of Richie Ulcer Guard™ has revealed spectacular results.  I have applied the product to the topcover of the existing foot orthoses of several patients with non-healing ulcers.  I saw immediate improvement and rapid healing when all other measures had failed.  These experiences have verified what many authorities have stated for years:  shearing forces are equal to or more damaging than pressure in the causation of skin ulceration in neuropathic feet.

Managing Pressure

The beauty of Richie Ulcer Guard™ is that it does not force you to choose between managing pressure and managing shear.   The Richie Ulcer Guard™ works in tandem with your preferred pressure off-loading techniques: i.e., insoles, orthotics, AFO braces or shoes.  The end result is a system that simultaneously addresses pressure and shear to prevent or treat skin ulceration.

Easy to Apply

 In a clinical setting, neuropathic patients can present with a new pre ulcerative trouble spot with no warning.  Practitioners need to be prepared to provide immediate intervention to off load the area with combined pressure and shear relief.  The Richie Ulcer Guard™ can be instantly applied to the patients’ existing footwear, insole, orthotic or AFO brace.   One patch can address any ulceration or hot spot in the forefoot or rearfoot.  

Targeting Relief to the Hot Spot

Targeting relief is critical.  Pressure and shear cause ulcerations . . . but they are also essential to ambulation.  Elimination of all pressure and shear can compromise function.   The key for managing both pressure and shear is to target relief at the trouble spots –the ulcer or the callosity as examples.  Practitioners know they cannot eliminate pressure entirely; it can only be dispersed.  Shear management is very similar – too much and the patient is sliding around in her shoes.  An essential aspect of the Richie Ulcer Guard™ is that it allows the practitioner to target shear relief to the hot spot while still allowing for efficient ambulation.

Increasing the Potential for Patient Mobility

Patients and the podiatrists are caught in a bind when a foot ulceration develops:  Movement is essential for overall health, but it can also exacerbate the ulceration by increasing the cumulative pressure and shear loads.  The Richie Ulcer Guard™   is designed to provide a powerful adjunct to off loading strategies which preserve patient mobility i.e. insoles and specialized footwear.   With the Richie Ulcer Guard™ cumbersome and challenging off loading with casts and Charcot Restraint Orthotic Walkers  ( CROWs) may be avoided.  However, when these devices are required, the Richie Ulcer Guard™ can also enhance ulcer off-loading.

Using the Richie Ulcer Guard™ in Your Practice

In the next few days or weeks, many patients will present to your clinic with various stages of peripheral neuropathy.  One patient may have heavy callusing on a foot, perhaps under the second metatarsal head.  For such a patient you might typically debride the callus and select an appropriate insole.  At this point, consider applying the Richie Ulcer Guard™ to the insole directly opposite the spot of heavy callusing under the second metatarsal head.  Because the Richie Ulcer Guard™ will reduce the friction and shear loads on that area, you should also observe a reduction in callus formation at the next visit.

Another patient may present with a non-healing ulcer on the great toe that has not responded to pressure relief alone.  For this patient you may have used an accommodative insert.  For this patient you might simply apply the Richie Ulcer Guard™ opposite the hallux on the accommodative insert.

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Please let me know how the Richie Ulcer Guard™ works for you and your patients.  Once you have used the Richie Ulcer Guard™ in your practice, I believe you will share my enthusiasm for this new modality which has significant potential to prevent ulcerations in neuropathic feet.

My e-mail address:  info@richieulcerguard.com

For more information on the Richie Ulcer Guard™, please visit www.richieulcerguard.com.
 

Sincerely,

Doug Richie D.P.M., FACFAOM