DIABETIC FOOT ULCER.pptx

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1. DIABETIC FOOT ULCER Presenter: Dr Zaid Supervisor: Dr Faiz

2. Definition Diabetic foot can be defined as infection, ulceration or destruction of tissues of the foot associated with neuropathy and/or peripheral arterial disease of people with diabetes mellitus (DM).

3. Clinical P resentation

4. Screening Peripheral Neuropathy Semmes-Weinstein Monofilament examination, tuning fork, Ipswich touch test Peripheral Arterial Disease Palpating foot pulse Ankle Brachial Index (ABI)

5. Diabetic Foot Risk Stratification

6. University of Texas Classification of Diabetic Foot

7. Prevention Patient education Metabolic control Glycaemic control (with minimisation of hypoglycaemia ) in the prevention of diabetic foot should be individualised Preventive footwear advised on appropriate footwear according to the foot risk Preventive surgery to prevent ulceration or re-ulceration in diabetic patients with foot deformity Gastrocnemius-soleus fascia recession, Achilles tendon lengthening (modified White’s technique), Percutaneous Tenotomy, Osteotomy

8. Preventive Footwear

9. Treatment Pharmacotherapy – analgesics, topical antimicrobial and systemic antiobiotic Wound management: non-surgical intervention Dressing Adjuvant therapy – negative pressure wound therapy, hyperbaric oxygen therapy, maggot debridement therapy surgical intervention Rehabilitation - Off-loading should be offered to patients with plantar diabetic foot ulcer and post amputation rehabilitation

10. Neuropathic Pain

11. Antibiotic

12. Wound Care Goals of wound care and dressings provide moist environment absorb exudate act as a barrier off-load pressure at ulcer

13. Surgical Intervention Surgical debridement Indications : fail to respond to non-surgical debridement, deep and infected at presentation Amputation Vascular reconstruction surgery (if feasible) should be performed prior to definitive surgical management

14. Reduction of plantar pressure (off-loading) Involves reducing the pressure to the diabetic foot ulcer, thus reducing the trauma to the ulcer and allowing it to heal Methods: Total non-weight bearing, total contact cast Foot cast or boots, r emovable walking braces with rocker bottom soles Total contact orthoses – custom walking braces Patellar tendon bearing braces, half shoe or wedge shoes Healing sandal – surgical shoe with molded plastizote insole Accommodative dressing: felt, foam, felted-foam, etc Assistive devices: crutches, walker, cane, etc.

15. Monitoring and Follow up

16. THANK YOU FOR YOUR ATTENTION 