Diabetic foot care and manegement

It's about diabetic foot manegement and care

1. DIABETIC FOOT CARE AND MANAGEMENT C H A N D A N C K 3 RD YEAR BPT

2. C O N T E N T : - -Diabetes:- introduction -Diabetic :- neuropathy Definition Classification Etiology Pathology C l i n i c a l f e a t u r e s Risk factors diagnosis

3. * Pt management -- Diabetic foot ulcer Definition Classification Etiology Pathology C l i n i c a l f e a t u r e s Risk factors mangement

4. I N T R O D U C T I O N D i a b e t e s m e ll i t u s i s a g r o u p o f m e t a b o l i c d i s e a s e s i n which there are high blood sugar levels over a prolonged period. L e a d i n g t o c o m p l i c a t i o n s l i k e : -- Diabetic Retinopathy -- Diabetic Nephropathy -- Diabetic Neuropathy

5. DIABETIC NEUROPATHY A t y p e o f n e r v e d a m a g e t h a t c a n o cc u r w i t h diabetes also called as diabetic nerve damage. R e l a t i v e l y e a r l y a n d c o mm o n c o m p l i c a t i o n s e f ecting approximately 30% of diabetic patients. A l t h o u g h i n a f e w p a t i e n t s i t c a n c a u s e s e v e r e d i s a b i l i t y , i t i s s y m p t o m l e s s i n m a j o r i t y .

6. Like retinopathy it occurs secondary to metabolic d i s t u r b a n c e o f d i a b e t e s a n d t h e d e g r e e o f m e t a b o l i c control.

7. CLASSIFICATION - - S O M A T I C - - V I S C E R A L *Polyneuropathy *Mononeuropathy * Cardiovascular * Gastrointestinal * vasomotor

8. E T I O L O G Y * T h e e x a c t c a u s e o f e a c h t y p e o f n e u r o p a t h y i s u n k n o w n . r e s e a r c h e r s t h i n k t h a t o v e r t i m e , u n c o n t r o l e d h i g h b l o o d s u g a r d a m a g e s n e r v e s a n d interferes with their ability to send signals, leading to diabetic neuropathy. High blood sugar also weakens t h e w a l l s o f t h e s m a l b l o o d v e s e l s t h a t s u pp l y t h e n e r v e s w i t h o x y g e n a n d n u t r i e n t s .

9. PATHOLOGY

10. C L I N I C A L F E A T U R E S Symptoms:- cramps numbne s h o t o r c o l d s e n s a t i o n tingling b o r i n g p a i n o r s t a bb i n g p a i n

11. Signs:- Distal weakne s A n k l e r e f l e x e s a r e a b s e n t Sensory lo s in a length related distribution with t h e t o e s a n d f e e t b e i n g m o s t a f f e c t e d .

12. R I S K F A C T O R S *Hyperglycemia * D u r a t i o n o f d i a b e t i e s *Age *Hypertension *Smoking

13. DIAGNOSIS Urinalysis for protein , glucose , microscopy –for evidence of nephropathy. H b a 1 c / g l u c o s e Urea and electrolytes L f t i n c l u d i n g g g t Thyroid function tests Serum protein electrophoresis Vitamin b12 levels

14. TREATMENT Tight control of blood sugar levels C a r e f o r t h e f ee t t o p r e v e n t c o m p l i c a t i o n s Control of pain caused by neuropathy -- anesthetic drugs -- Narcotics -- Tricyclic antidepressants -- Alpha – lipoic acid

15. PT MANAGEMENT E x e r c i s e s - - -- - : w a l k i n g : G a i t t r a i n i n g : P o s t u r a l t r a i n i n g : A e r o b i c e x e r c i s e Modalities used to relief pain are :- * tens Laser therapy [ low intensity] Massage

16. DIABETIC FOOT ULCER

17. DEFINITION A non healing or poorly healing, break in the skin, below the ankle in an individual with diabetes, critical i n t h e n a t u r a l h i s t o r y o f t h e d i a b e t i c f o o t .

18. Studies have indicated that diabetic patients have up t o a 2 5 % l i f e t i m e r i s k o f d e v e l o p i n g a f o o t u l c e r . The annual incidence of diabetic foot ulcers is 3% to a s h i g h a s 1 % .

19. CLASSIFICATION

20. E T I O L O G Y H i g h b l oo d s u g a r l e v e l s Dry skin C a l u s e s Bad glycaemic control Ulcer

21. PATHOPHYSIOLOGY Neuropathy--- leads to skin dryness and cracks, foot deformity and loss of protective sense in the foot. Microangiopathy/ vascular disease--- lead to poor blood supply to the toes and foot and then ulcerate easily. Immunopathy --- defects in leukocyte function and also deficient white ce l chemotaxis and adherence.

22. C L I N I C A L F E A T U R E S Osteomyelitis Septic arthritis Gangrene Chronic non – healing ulcer Soft tissue infection

23. R I S K F A C T O R S Neuropathy Old age Duration of diabetes Poor vision Foot deformity L i m i t e d j o i n t m o b i l i t y Abnormal foot pressures Previous ulceration

24. MANAGEMENT Objectives:- Control infection P r e v e n t a m p u t a t i o n P r e v e n t r e c u rr e n t u l c e r U l c e r / w o un d m a n a g e m e n t M a i n t a i n p r e - m o r b i d f oo t

25. G E N E R A L M A N A G E M E N T A multidisciplinary aproach Good diabetic control Advise to stop smoking Optimize other co-morbid complications Systemic antibiotics

26. LOCAL MANAGEMENT W o un d / u l c e r m a n a g e m e n t Debride infected/ necrotic ti s ue Amputation may be the treatment of choice Minimize risk of re-infection Re-established adequate blood supply G o o d f o o t c a r e a n d f o o t w e a r .

27. REFERENCE Davidson’s principles and practice of medicine.

28. Thankyou