Diabetic foot and foot care.pptx

Diabetic foot and Foot care
Dr Joel Arudchelvam
Definition
Prevalence
Teaching Hospital Anuradhapura [THA]

High risk foot

Neuropathy

Pathogenesis of neuropathy
Charcot foot
Testing for neuropathy
Local Ulcer care

1. Diabetic foot and Foot care Dr Joel Arudchelvam MBBS (COL), MD (SUR). MRCS (ENG), FCSSL Consultant Vascular and Transplant Surgeon, Senior lecturer, department of Surgery, faculty of medicine, University of Colombo.

2. Diabetic foot Infection, ulceration or destruction tissues and bones with associated neuropathy and occlusive arterial disease in a patient with DM ( WHO definition)

3. Diabetic mellitus Sri Lanka I n 2005 - diabetes mellitus 14.2 % males 13.5 % females

4. Diabetic foot Teaching Hospital Anuradhapura [THA] 100 patients 81 [81%] males mean age - 67.6 years Diabetes mellitus - 65 [65%] Arudchelvam, J. and De Soyza, M., 2022. Pattern of occlusive disease in lower extremity arteries in patients qualifying for revascularization in a North Central Province tertiary care centre in Sri Lanka. Sri Lanka Journal of Surgery , 40(2), p.20-23.DOI: https://doi.org/10.4038/sljs.v40i2.8794

5. Diabetic foot University of Colombo D iabetes mellitus - 80%

6. Diabetic foot 4% -10% foot ulcer risk in DM 40% - 60% of all lower limb amputation 85% of amputation are preceded by foot ulcer

7. Diabetic foot Neuropathy Ischemia I nfection U lcer Bone destruction

8. High risk foot • History: Previous ulcer/lower extremity amputation , claudication • Absence of pedal pulses • Loss of protective sensation

9. Neuropathy Prevalence 7% within 1 year of diagnosis 50% >25 years

10. Neuropathy • Increased risk for: Foot ulceration amputation Neuropathic pain Significant morbidity Usage of resources

11. Pathogenesis of neuropathy Progressive nerve fiber loss  Mechanisms Polyol pathway – hyperglycaemia - glucose to sorbitol Advanced  glycation  end products (AGEs)

12. Neuropathy Sensory – Glove and stocking type Motor Autonomic

13. Ischemia Increased atherosclerosis Vascular disease Ulcer Gangrene

14. Ulcer In distal part of limb (forefoot or toes) Dry painful

15. Gangrene Death of tissue with infection Dry – infection is limited to dead tissue and the margins Wet - infection extends up

16. Charcot foot Due to reduced pain sensation and proprioception Resulting in Fracture joint destructions Collapse of the arch of the foot Inflammation ar

17. Osteomyelitis Sinus opening

18. Testing for neuropathy Pressure perception Semmes-Weinstein 10 gram monofilament Vibration perception: 128 Hz tuning fork

19. Semmes-Weinstein 10 gram monofilament

20. Prevention and management Patient education

21. Neuropathy - off loading

22. Nail cutting

23. Foot wear

24. Foot wear

25. Local Ulcer care Wound toilet Process of removal of slough, dead tissue, foreign bodies and draining pus. Following a wound toilet the wound base is made suitable for future granulation and epithelialisation.

26. D etection of ischemia and Revascularisation

27. Bypass

28. Angioplasty and/ Stenting

29. Avoid Do not apply gauze bandage tightly around limbs, digits – causes ischaemia Use – plaster , crepe instead

30. Summary Diabetes mellitus is a leading cause of limb loss Identification of high risk foot and prevention of ulcers is the mainstay of management

31. Thank You