Footcare

sri lanka

1. Foot care

2. Why foot care is important? Diabetes is leading cause of non traumatic amputation and 80% of them start with an ulcer Globally major amputation happens once in every 20 seconds 10%-20% of patient die with in a year after major amputation. 47% of hospitalization of patients with diabetes is due to foot problems ( Fernando. D(1996) The prevention of neuropathic foot ulceraion in sri lankan Diabetes patient, ceylon medical Journal,41(3), 96-98 )

3. “ Every 30 minutes a limb is lost due to landmines, “Every 30 seconds a limb is lost due to Diabetes,

4. Understanding the diabetes foot disease syndrome Amputation Infection Ulcer Small lesion Foot at risk Management, delayed Referral, wrong decision

5. What goes wrong with Diabetic foot ? Four great pathology Neuropathy Ischemia Infection Deformity

6. Neuropathy Motor Sensory Autonomic Muscle wasting foot Weakness postural deviation Deformities, stress And shear pressure Proprioception Unawareness of Foot position Stress on bones &pressure Joints planar Callus formation Reduced sweating Dry skin Fissure and crackers Infection Trauma Ulcer

7. Peripheral arterial Disease High body sugar expedite atherosclerosis cause peripheral vascular disease (reduction of blood supply to the foot) The delivery of essential nutrients and oxygen to the foot is compromised leading to anaerobic infection and tissue necrosis

8. Peripheral arterial disease Atherosclerosis narrows or blocks the arterial lumen Foot ischemia Foot ulcer Necrosis/Gangrene

9. Clinical presentation Neuropathic foot Neuro -ischemic foot Severe ischemia foot Charcot foot Early diagnosis is important

10. Neuropathic foot 70% of people with diabetes have peripheral nerve damage They lose sensation and protective against external insults to foot They may also have a Motor causing deformity and Autonomic neuropathy causing dryness of the skin This can change the shape and mechanisms of the foot

11. Impact of neuropathy Inability to respond appropriately to external stresses / insult Physical trauma Bacterial invasion Callus and ulceration in high pressure points Fissure due to dryness (sweat and sebaceous gland denervation)

12. Treatment Wound care Offloading footwear Surgical offloading

13. Charcot foot Charcot foot is condition causing weakening of the bones in the foot that can occur in the people who have significant nerve damage 25% of diabetes with this pathology had wrong initial diagnosis Eg : infection, gout, arthritis, fracture, venous insufficiently and tumor

14. Charcot neuro arthopathy and diabetes General characteristics :- Dense bones( sbchondral sclerosis) Degeneration Destruction of articular cartilage Deformity Debris dislocation

15. Treatment Early presentation Immobilization-cast(8 to 12) later removable braces or a charcot restraint orthotic walker(4-6 months) Late deformed foot footwear Surgery

16. Assessment of the foot Simple Inspection Palpation Sensory testing

17. Examination of the feet Perform inspection of feet in a well lit room Inspect colour of the skin, presence of thickness , dryness and lack of sweating or presence of fissures Look for presence of callus/blistering, nail dystrophy , or paronychia Inter digital areas: check for signs of ulceration or erythema Focal or global skin temperature differences Inspect footwear Evaluation for any gross deformity

18. General inspection Neuropathy Ischemia Deformity Oedema Footwear

19. Features of Neuropathic Foot Deformity Infection Callus Ulceration Sensory Loss Dry skin Fissures High pressure points Nail dystrophies

20. Features of Ischemic Foot Nail dystrophies Cool Colour Thin callus Soft tissues Atrophy Depressions Pain Reduced pulses Gangrene

21. Heel Fissures

22. Examine the Footwear

23. Neuropathy Testing 10 g Semmes- Weinstein Monofilement test ▪ Demonstrate on forearm or hand ▪ Place monofilament perpendicular to test site ▪ Bow in to C shape foe 1-2 second ▪ Avoid calluses, scars, and ulcers ▪ An abnormal response is the of the perception of pressure by the monofilament .

24. Testing for Perfusion Pedal pulse Dorsalis pedis Posterior Tibial

25. Assessment of Deformity Claw Tow deformity Hammer toe deformity Charcot deformity Bunion Overlapping toe

26. Management of diabetic foot Self examination of feet by the patient Regular screening by health care personnel Appropriate footwear Foot care clinic with multidisciplinary team

27. Assessment of Footwear Secure Closure System Less steaming Extra Depth Stable Heel Counter Roomy Toe Box Hard outer sole

28. Self-care of feet in nine steps Step 1: wash feet daily with lukewarm water and soap Step 2: dry the feet well, especially between the toes Step 3: keep the skin supple with application of a moisturizing lotion , but do not apply this in between toes Step 4: check the feet for sores, blisters or cuts. Use a mirror Step 5: trim the toe nails straight across and file the edges with a nail file

29. Self-care of feet in nine steps ctd … Step 6: change in to clean dry socks daily. Make sure socks are not too tight or too loose Step 7: always wear shoes or footwear that fits well. Now there are footwear that are specially designed for people with diabetes Step 8: never walk barefoot, either outdoors or indoors Step 9: inspect your footwear daily for cracks, pebbles, nails or anything that could hurt your feet

30. THANK YOU