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![Page 1: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/1.jpg)
Deformities inDiabetic Feet
Klaus Kirketerp-Møller, Consultant, Ph.d. stud
Copenhagen Wound Healing Center
Bispebjerg University Hospital, Denmark
![Page 2: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/2.jpg)
Deformities
•Not Related to Diabetes •Bunion
•Hallux valgus
•Hallux rigidus
•Flat foot
•Hammer toes
•Mallet toes
![Page 3: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/3.jpg)
Deformities
•Related to diabetes
![Page 4: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/4.jpg)
Deformities
•Related to neuropathy •Hammer toes/mallet toes
•Prominent metatarsal heads
•Equinus feet
•Charcot
•Others
![Page 5: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/5.jpg)
Treatment of Non-Diabetes Related Deformities
•Normal protocol
• No neuropathy
• Adequate perfusion
•Attenuated Protocol
• Neuropathy
• Adequate perfusion
”Compliance” is closely linked to neuropathy
![Page 6: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/6.jpg)
The Attenuated Protocol
•Augmented fixation
•Augmented off-loading
•Prolonged off-loading
•Therapeutic footwear
•Crutches?
![Page 7: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/7.jpg)
Deformities
•Related to neuropathy •Hammer toes/mallet toes
•Prominent metatarsal heads
•Equinus feet
•Charcot
•Others
![Page 8: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/8.jpg)
The Imbalance theory
•The Neuropathy affects • Sensory fibers
• Altered sensation
• Pain Fibers
• Absent pain perception
• Neuropathic pain
• Proprioception
• Balance
• Motion coordination
• Temperature sensation
• Autonomic function
• Sweating
![Page 9: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/9.jpg)
When to Suspect Neuropathy
•Professional approach
• Longstanding diabetes
• Alcohol ”overuse”
• Clinical examination
- Monofilament
- Vibration threshold
- Neuropad
• Nerve velocity
•Practical approach
• Present or previous foot
ulcer
• Deformity
• Clinical presentation of
- Dry skin
- Callosities
- Fissures
- Atrophy of fat or muscles
![Page 10: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/10.jpg)
Toe Deformities
•Hallux rigidus
•Hallux valgus
•Hammertoes
•Mallet toes
•Deviations
•Hyperextension toes
![Page 11: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/11.jpg)
Metatarsal Deformities
•Prominent metatarsal heads
• Dorsal subluxation of MTP
Joint
•Hallux valgus
•Spread-foot
![Page 12: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/12.jpg)
Midfoot deformities
•Eversion deformity
•Flat-foot deformity
•Charcot deformity
![Page 13: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/13.jpg)
Etiology
•Eversion deformity •Muscle imbalance
• Neuropathy
• Surgery
• Rupture
- Infection
- Inflammation
- Traumatic
![Page 14: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/14.jpg)
Hindfoot Deformities
•Equinus deformity
• Fixed
• Redressable
![Page 15: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/15.jpg)
Ankle deformity
•Traumatic
• Ankle fracture
•Charcot
![Page 16: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/16.jpg)
How I work
![Page 17: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/17.jpg)
Daily Living Activities
•Bying Shoes
• Appearence
• Appearence
• Appearence
• Function
• Fit
•Ordering Shoes
• Function and Fit
• Appearence
[email protected] UCM Lecture
EWMA 2016
Bremen
![Page 18: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/18.jpg)
Where´s Wally?
EWMA UCM Lecture
EWMA 2016
Bremen
![Page 20: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/20.jpg)
How I work
85 %
![Page 21: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/21.jpg)
Examination
EWMA UCM Lecture
EWMA 2016
Bremen
![Page 22: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/22.jpg)
The Story of Cuno
EWMA UCM Lecture
EWMA 2016
Bremen
![Page 23: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/23.jpg)
Recapture
• Appearance
• Stigmata
• Pass the Examination
• Lack of recognition (Steps, Load)
[email protected] UCM Lecture
EWMA 2016
Bremen
![Page 26: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/26.jpg)
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Recapture
• Appearence
• Stigmata
• Pass the Examination
• Lack of recognition (Steps, Load)
• Lack of fear
[email protected] UCM Lecture
EWMA 2016
Bremen
![Page 29: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/29.jpg)
The Anthropological Approach
Illness, Normality and Self-management: Diabetic Foot Ulcers and the Logic
of Choice
Signe Lindgaard Andersen & Vibeke Steffen
[email protected] UCM Lecture
EWMA 2016
Bremen
![Page 30: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/30.jpg)
Discourse
Having DiabetesBeing a
person with Diabetes
[email protected] UCM Lecture
EWMA 2016
Bremen
Diabetic Patients Diabetics
1980-
Identity
Management
![Page 31: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/31.jpg)
Three ”Typical” Cases
•Jytte
• The in-experienced
•Preben
• The experienced
•Mathias
• End- stage
•"Normally, I don’t have
foot ulcers"
•"I have a son and he gets
no food then"
•"If only I had listened
properly"
[email protected] UCM Lecture
EWMA 2016
Bremen
![Page 32: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/32.jpg)
Recapture
• Appearence
• Stigmata
• Pass the Examination
• Lack of recognition (Steps, Load)
• Lack of fear
• Self-management
• ”Did I pass?”
• Guilt and Depression
[email protected] UCM Lecture
EWMA 2016
Bremen
![Page 33: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/33.jpg)
EWMA UCM Lecture
EWMA 2016
Bremen
![Page 34: Deformities in Diabetic Feet - dfas.ortopaedi.dkdfas.ortopaedi.dk/wp-content/uploads/2016/06/... · Deformities in Diabetic Feet Klaus Kirketerp-Møller, Consultant, Ph.d. stud Copenhagen](https://reader036.vdocuments.us/reader036/viewer/2022062606/600b7f2462eab00f1607d716/html5/thumbnails/34.jpg)
Now -go home and change..
Thank you for your attention.
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