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THE DIABETIC FOOT

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OSTEOMYLITIS Diabetic Foot Ulcer Treatment Modalities Microbiological ... Identification of high risk patient Education of ... presentation format: On ... – PowerPoint PPT presentation

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Title: THE DIABETIC FOOT


1
THE DIABETIC FOOT
  • DR.SEIF I M ELMAHI
  • MD, FRCSI
  • University of Khartoum, Sudan

2
CONTENT
  • Definition
  • Epidemiology
  • Social Economic factors
  • Pathophysiology of foot ulceration
  • Diabetic Neuropathy
  • Peripheral Vascular Disease Diabetes
  • Biomechanics of Foot Wear
  • The Diabetic Foot Ulcer Outcome Management
  • Neuro-osteoarthropathy
  • Amputation in Diabetic Patient
  • Prevention of Foot Problem

3
Diabetic Foot
  • Definition
  • Infection, ulceration or
    destruction of deep tissues associated with
    neurological abnormalities various degrees of
    peripheral vascular diseases in the lower limb

  • (based on WHO definition)

4
Epidemiology
  • 40 - 60 of all non traumatic lower limb
    amputation
  • 85 of diabetic related foot amputation are
    preceded by foot ulcer
  • 4 out of 5 ulcer in diabetics are precipitated
    by trauma
  • 4 -10 is the prevalence of foot ulcer in
    diabetics

5
Epidemiology
  • In Sudan
  • Prevalence of DM ? 6 12
  • DSF inpatient KTH
  • 30 - 40 risk of major amputation
  • 8 - 20 mortality

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7
Social Economic Factors
  • Diabetic foot complications are expensive
    (cost of healing 7000-10000 USD)
  • (healing with amp.
    43000-63000USD)
  • In Khartoum (4 weeks
    dressing cost 110000SD)
  • Intervention of foot care is cost effective in
    most societies
  • Scarce information regarding long term prognosis

8
Pathophsiology of Foot Ulceration
  • Neuropathic
  • Ischemic
  • Neuro -ischemic

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10
STAGES OF ULCER DEVELOPMENT
11
STAGES OF ULCER DEVELOPMENT
12
Diabetic Neuropathy
  • Sensorimotor peripheral sympathatic neuropathy
    are major risk factors for ulcer
  • History careful foot examination are mandatory
    to diagnose neuropathy
  • Up to 50of type2 diabetic patient have
    significant neuropathy at risk of foot ulcer

13
Periphral vascular disease diabetic PVD
  • PVD is the most important factors related to
    outcome of diabetic foot ulcer
  • PVD is diagnosed by simple clinical examination
  • non invasive vascular test determines probability
    of healing
  • Symptoms of ischemia may be masked by neuropathy
  • Microangiopathy shouldn't be accepted as primary
    cause of ulcer
  • Conservative approach for treatment
  • Outcome of revascularization is similar to that
    in non-diabetic

14
Biomechanics of foot wear
  • Biomechanical abnormalities are consequence of
    neuropathy, they lead to abnormal foot pressure
  • Foot deformity neuropathy increase the risk of
    ulcer
  • Pressure relief is essential for ulcer healing
    and/or prevention
  • Frequent inspection of shoes insoles is
    mandatory
  • Appropriate foot wear significantly reduce ulcer
    recurrence

15
Diabetic Foot Infection
  • Infection in diabetic foot is limb threatening
  • Signs of infection may be absent in diabetic pt.
    with foot ulcer
  • Superficial infection is usually caused by gram
    ve cocci, deep infection is poly microbial
  • Surgical debridment is essential in acute deep
    infection
  • Osteomylitis( diagnoses treatment)

16
Neuro-osteoarthropathy
  • Non- infective pathology
  • Should be suspected in any swollen hot
    erythematous foot
  • Differentiation from infection is important to
    prevent misdiagnosis possible amputation
  • Treatment should aim at preventing severe
    deformity

17
Diabetic Foot Ulcer Treatment
  • Multidisciplenary approach
  • Staging dictate the treatment option
  • Continuity of care life long observation

18
Amputation in Diabetic Patient
  • Increased minor\major amputation increased the
    no. of deformed feet
  • Minor amputation is needed
  • Gangrene
  • As part of debriment
  • for correction of foot deformities
  • Minor amputation doesnt significantly compromise
    walking ability

19
Major Amputation
  • Risk of loss walking ability
  • Mortality
  • Risk of contra-lateral amputation
  • Strict indication
  • Careful choice of the level

20
How To Prevent Foot Problems
  • 5 corner stones
  • Regular inspection examination of foot foot
    wear
  • Identification of high risk patient
  • Education of patient, family health care
    providers
  • Appropriate foot wear
  • Treatment of non ulcerative pathology

21
THANKYOU
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23
SENSORY NEUROPATHY
24
Diabetic Neuropathy
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27
PERIPHRAL VASCULAR DISEASE
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29
Biomechanics of foot wearAREAS AT RISK OF
ULCERATION
30
FOOT WEAR
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33
FOOT WEAR
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35
OSTEOMYLITIS
36
Diabetic Foot Ulcer Treatment Modalities
  • Microbiological control
  • Wound control
  • Vascular control
  • Mechanical control
  • Metabolic control
  • Educational control

37
Staging of Diabetic Foot
  • Stage Clinical condition
  • 1 Normal
  • 2 High risk
  • 3 Ulcerated
  • 4 cellulitic
  • 5 Necrotic
  • 6 Major
    amputation

38
Assessment of Diabetic Foot
  • Neuropathy
  • Ischemia
  • Deformity
  • Callus
  • Swelling
  • Skin breakdown
  • Infection
  • Necrosis

39
NEURO-OSTEOARTHROPATHY(CHARCOT FOOT)
40
NEURO-OSTEOARTHROPATHY(CHARCOT FOOT)Neuro-osteoart
hropathy
41
PODIATRY
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