Diabetic Foot Care - PowerPoint PPT Presentation

1 / 110
About This Presentation
Title:

Diabetic Foot Care

Description:

MOTOR NEUROPATHY. Weakness, atrophy, foot drop. Structural ... The Independent Effects of Peripheral Vascular Disease, Sensory Neuropathy and Foot Ulcers. ... – PowerPoint PPT presentation

Number of Views:7866
Avg rating:3.5/5.0
Slides: 111
Provided by: mariannej
Category:

less

Transcript and Presenter's Notes

Title: Diabetic Foot Care


1
Diabetic Foot Care
  • Marianne Misiewicz, DPM, AACFAS
  • Columbia, MO

2
(No Transcript)
3
(No Transcript)
4
STATISTICS
  • 24 million Americans have diabetes, approximately
    7 of the population (CDC 2008)
  • 15-25 will develop ulcers on their feet.
  • 20 of diabetics admitted to hospitals because of
    foot problems
  • Nearly 98 billion spent annually for direct and
    indirect medical costs(1997).
  • OBrien, JA, et al. Direct Medical Costs of
    Complications Resulting from Type 2 Diabetes in
    the US. Diabetes Care vol 21 7, July 1998.

5
STATISTICS
  • 625,000 new cases of diabetes/year
  • 178,000 deaths/year from disease and related
    complications.
  • Nearly half of nontraumatic LEA caused by
    diabetes.
  • Average acute hospital cost in 1996 for a foot
    ulcer 9,910.
  • 5 year survival rate 50 for BKA
  • OBrien, JA, et al. Direct Medical Costs of
    Complications Resulting from Type 2 Diabetes in
    the US. Diabetes Care vol 21 7, July 1998.

6
STATISTICS
  • 50 of diabetics with LEA require 2nd LEA within
    5 years of initial amputation.
  • Often require care outside of hospitalization
    (80) including
  • Prosthetic device
  • Physician visits
  • Wound care/Home Health
  • OBrien, JA, et al. Direct Medical Costs of
    Complications Resulting from Type 2 Diabetes in
    the US. Diabetes Care vol 21 7, July 1998.

7
STATISTICS
  • Greater than 50 of all non-traumatic amputations
    are diabetics
  • 0.5 billion dollars for hospital and surgical
    costs per year
  • 5 year survival rate 50 s/p amputation.

8
STATISTICS
  • Diabetes is the 4th leading cause of death by
    disease in the United States
  • Diabetics are 2-4 times more likely to experience
    heart disease and strokes
  • Is the leading cause of ESRD
  • Is the leading cause of blindness in adults gt 75
    y/o.

9
(No Transcript)
10
  • 53 of family physicians reported adherence to
    semi-annual foot exams for patients with Type II
    diabetes
  • 64 reported adherence with Type I diabetics.

11
  • Fewer than 20 of diabetic patients are regularly
    given foot examinations by their primary care
    physicians

12
(No Transcript)
13
FOOT EXAM
  • Skin Integument
  • Vascular
  • Neurological
  • Musculoskeletal
  • Shoegear

14
FOOT EXAM
  • Skin and Integument
  • A. Color
  • B. Temperature
  • C. Texture
  • D. Hair Growth
  • E. Moisture
  • F. Lesions-location, size, type
  • G. Condition of toenails

15
(No Transcript)
16
FOOT EXAM
  • Vascular exam
  • A. Color
  • B. CFT
  • C. Varicosities/Edema
  • D. Pulses (DP and PT)

17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
FOOT EXAM
  • Neurological
  • A. Light touch
  • B. Sharp-dull discrimination
  • C. Vibratory
  • D. Proprioception
  • E. Protective sensation
  • F. DTR

21
(No Transcript)
22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
FOOT EXAM
  • Musculoskeletal
  • A. General appearance(gross deformities)
  • B. Muscle strength/function
  • C. Muscle tone
  • D. ROM

27
(No Transcript)
28
(No Transcript)
29
(No Transcript)
30
(No Transcript)
31
FOOT EXAM
  • Shoe Gear
  • A. Everyday shoe style
  • B. Dress shoe style
  • C. Exercise shoes
  • D. Shoe inserts/orthoses
  • E. Special shoe needs

32
SHOES
33
(No Transcript)
34
(No Transcript)
35
(No Transcript)
36
SUPPORTIVE DEVICES
37
(No Transcript)
38
(No Transcript)
39
(No Transcript)
40
(No Transcript)
41
(No Transcript)
42
(No Transcript)
43
(No Transcript)
44
(No Transcript)
45
(No Transcript)
46
(No Transcript)
47
(No Transcript)
48
(No Transcript)
49
(No Transcript)
50
(No Transcript)
51
(No Transcript)
52
(No Transcript)
53
(No Transcript)
54
COMMON FOOT AILMENTS AND THEIR TREATMENTS
  • Toenails
  • Corns/Calluses
  • Xerosis
  • Bunions/Hammertoes/other musculoskeletal problems

55
COMMON FOOT AILMENTS AND THEIR TREATMENTS
  • Vascular disease
  • Neuropathy
  • ULCERATIONS

56
TOENAILS
  • OnychomycosisFungal nails
  • Onychocryptosisingrown nail
  • Onychogryphosisthickened(Rams horn) nail
  • Onycholysiscrumbly nail
  • Onychia/Paronychiaabscessed/infected nail

57
(No Transcript)
58
(No Transcript)
59
(No Transcript)
60
CORNS
61
(No Transcript)
62
(No Transcript)
63
(No Transcript)
64
(No Transcript)
65
CALLUSES
  • Location
  • Cause
  • Treatment
  • Prevention

66
CALLUSES
  • CAUSEPRESSURE
  • Usually a bony prominence

67
(No Transcript)
68
CALLUSES
  • MEASURES TO ELIMINATE PRESSURE POINTS
  • Podiatric consultation for debridement
  • Shoe modifications, insoles, orthotics
  • Elective surgery on deformity

69
(No Transcript)
70
HALLUX ABDUCTOVALGUS
  • AKA-BUNIONS

71
(No Transcript)
72
HAMMERTOES
  • HAMMER DIGIT SYNDROME

73
(No Transcript)
74
VASCULAR DISEASE
  • ARTERIAL DISEASE
  • A. Large vessel
  • B. Small vessel
  • C. Microvasculature
  • VENOUS DISEASE
  • A. Varicosities
  • B. Venous stasis

75
(No Transcript)
76
NEUROPATHY
  • PERIPHERAL SENSORY NEUROPATHY
  • MOTOR NEUROPATHY
  • AUTONOMIC NEUROPATHY

77
PERIPHERAL SENSORY NEUROPATHY
  • Glove and Stocking distribution
  • Paresthesia
  • Anesthesia

78
MOTOR NEUROPATHY
  • Weakness, atrophy, foot drop
  • Structural deformities(ie hammertoes, pes cavus)

79
AUTONOMIC NEUROPATHY
  • Sympathetic Failure-microvascular dilation
  • Anhidrosis

80
(No Transcript)
81
ULCERATION
  • WAGNER CLASSIFICATION FOR DIABETIC FOOT LESIONS
  • Grade 0 No open lesion(callus may be present)
  • Grade 1 Superficial Ulcer
  • Grade 2 Deep Ulcer to Tendon, Capsule or Bone

82
ULCERATION
  • WAGNER CLASSIFICATION FOR DIABETIC FOOT LESIONS
  • Grade 3 Deep Ulcer with abscess, osteomyelitis,
    joint sepsis
  • Grade 4 Localized gangrene
  • Grade 5 Gangrene of entire foot

83
ULCERATIONS
  • DESCRIPTION
  • SIZE(L x W x D)
  • DURATION
  • LOCATION
  • DRAINAGE/INFECTION
  • ODOR
  • BASE/RIM

84
ULCERATIONS
  • TREATMENT PROTOCOL
  • GRADE 0
  • Proper shoe/orthotics
  • Education
  • Palliative Podiatric care
  • Prophylactic surgery
  • Prevention

85
(No Transcript)
86
(No Transcript)
87
ULCERATIONS
  • TREATMENT PROTOCOL
  • GRADE 1
  • Antibiotic therapy
  • Wound care
  • Radiographs
  • Surgery
  • Same as Grade 0

88
(No Transcript)
89
(No Transcript)
90
(No Transcript)
91
(No Transcript)
92
(No Transcript)
93
ULCERATIONS
  • TREATMENT PROTOCOL
  • GRADE 3
  • Hospitalize/IV abx
  • Aggressive ID/Debridement
  • Radiograph/Bone scan/MRI r/o OM
  • Metabolic control
  • Plastic surgical closure prn

94
(No Transcript)
95
(No Transcript)
96
(No Transcript)
97
(No Transcript)
98
(No Transcript)
99
(No Transcript)
100
(No Transcript)
101
(No Transcript)
102
(No Transcript)
103
(No Transcript)
104
(No Transcript)
105
(No Transcript)
106
(No Transcript)
107
(No Transcript)
108
CONCLUSION
  • PREVENTION CYA
  • Multidisciplinary team-coordinated by PCP
  • Patient education
  • Daily foot inspections by patient
  • Shoegear changes
  • Elective surgery to decrease risk

109
(No Transcript)
110
References
  • OBrien JA, et al. Direct Medical Costs of
    Complications Resulting From Type 2 Diabetes in
    the US. Diabetes Care 1998 217 pp 1122-8.
  • Sussman, KE. The Diabetic Foot Problem-A Failed
    System of Healthcare? Diabetes Res Clin Pract
    1992171-8.
  • Saar WE, Lee TH, Berlet GC. The Economic Burden
    of Diabetic Foot and Ankle Disorders. Foot Ankle
    Int. 2005 Jan 26(1)27-31.
  • Singh N, Armstrong DG, Lipsky BA. Preventing
    Foot Ulcers in Patients with Diabetes. JAMA.
    2005 Jan 12293(2)217-28.
  • Adler AI, Boyko EJ, Abroni JH, Smith DG.
    Lower-extremity Amputation in Diabetes. The
    Independent Effects of Peripheral Vascular
    Disease, Sensory Neuropathy and Foot Ulcers.
    Diabetes Care 199922(7) 1029-35.
  • Honghong Zhou, et al. A Computer Simulation
    Model of Diabetes Progression, Quality of Life,
    and Cost. Diabetes Care 2005282856-63.
Write a Comment
User Comments (0)
About PowerShow.com