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Unformatted text preview: THE DIABETIC FOOT
DR.SEIF I M ELMAHI
MD, FRCSI University of Khartoum, Sudan 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 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) 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 Epidemiology
In Sudan: Prevalence of DM ? 6 12 % DSF inpatient KTH : 30% - 40% risk of major amputation 8% - 20% mortality 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 Pathophsiology of Foot Ulceration Neuropathic Ischemic Neuro -ischemic STAGES OF ULCER DEVELOPMENT STAGES OF ULCER DEVELOPMENT Diabetic Neuropathy Sensorimotor & peripheral sympathatic neuropathy are major risk factors for ulcer History & careful foot examination are mandatory to diagnose neuropathy Up to 50%of type2 diabetic patient have significant neuropathy & at risk of foot ulcer 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 nondiabetic 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 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) Neuro-osteoarthropathy Non- infective pathology Should be suspected in any erythematous foot Differentiation from infection is important to prevent misdiagnosis & possible amputation Treatment should aim at preventing severe deformity swollen hot Diabetic Foot Ulcer Treatment Multidisciplenary approach Staging dictate the treatment option Continuity of care & life long observation 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 doesn't significantly compromise walking ability Major Amputation Risk of loss walking ability Mortality Risk of contra-lateral amputation Strict indication Careful choice of the level 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 SENSORY NEUROPATHY Diabetic Neuropathy PERIPHRAL VASCULAR DISEASE Biomechanics of foot wearAREAS AT RISK OF ULCERATION WEAR FOOT FOOT WEAR OSTEOMYLITIS Diabetic Foot Ulcer Treatment Modalities Microbiological control Wound control Vascular control Mechanical control Metabolic control Educational control Staging of Diabetic Foot
1 2 3 4 5 6 Clinical condition
Normal High risk Ulcerated cellulitic Necrotic Major amputation Assessment of Diabetic Foot Neuropathy Ischemia Deformity Callus Swelling Skin breakdown Infection Necrosis NEURO-OSTEOARTHROPATHY(CHARCOT
Neuro-osteoarthropathy)FOOT PODIATRY ...
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This note was uploaded on 03/08/2012 for the course PHARM 300 taught by Professor Staff during the Fall '11 term at Rutgers.
- Fall '11