diabetic foot an overview foot team prof.mamdouh el nahas prof.hanan gawish dr. manal tarshoby...
TRANSCRIPT
![Page 1: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/1.jpg)
![Page 2: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/2.jpg)
Diabetic Foot An Overview
Foot team• Prof.Mamdouh El Nahas
• Prof.Hanan Gawish
• Dr. Manal Tarshoby
• Dr.Omnia State
![Page 3: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/3.jpg)
Put Feet FirstPrevent Amputations
Diabetes and Foot Care
World Diabetes Day 2005
![Page 4: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/4.jpg)
2005: a Year-long Campaign
![Page 5: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/5.jpg)
Campaign Objectives
• Inform people of the extent of diabetic foot problems worldwide.
• Persuade people that action is both possible and affordable.
• Warn people of the consequences of not taking action.
![Page 6: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/6.jpg)
FOOT FACTS (1)
• Every 30 seconds a leg is lost to diabetes somewhere in the world.
• Up to 70% of all leg amputations happen to people with diabetes.
• DF problems are the commonest cause of hospital admission. (by us?)
![Page 7: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/7.jpg)
FOOT FACTS (2)
• Most amputations begin with a foot ulcer.
• One in every six people with diabetes will have a foot ulcer during their lifetime.
• Good News Up to 85% of amputations can be avoided.
![Page 8: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/8.jpg)
Egypt Representative
Mansoura University
Prof.Mamdouh El Nahas.
Dr.Hanan Gawish
Dr. Manal Tarshoby
Dr.Omnia Stat
![Page 9: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/9.jpg)
Levels of foot management
• Level 1 General practitioner, diabetic
nurse and podiatrist
• Level 2 Diabetologist, surgeon (general
and/or vascular and/or orthopedic),
diabetic nurse and podiatrist
• Level 3 Specialized foot center
![Page 10: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/10.jpg)
Value of Podiatric Care
0
2
4
6
8
10
12
14
84 85 86 87
Year
% A
mp
uta
tio
ns •KINGS COLLEGE HOSPITAL.
•1984 establishment of DIABETIC FOOT CLINIC.
•Amputation decreased 50% in 3 years.
![Page 11: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/11.jpg)
Diabetic Foot
![Page 12: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/12.jpg)
Diabetic Foot Disease
• Ischaemia• Neuropathy• Infection• Structural deformity • Ulcer• Amputation
![Page 13: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/13.jpg)
Five cornerstones of the management of the diabetic foot
Regular inspection and examination of the foot.Identification of the foot at risk.Education of patient, family and healthcare providers.Appropriate footwear.Treatment of non ulcerative pathology
![Page 14: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/14.jpg)
Five cornerstones of the management of the diabetic foot
Regular inspection and examination of the foot.Identification of the foot at risk.Education of patient, family and healthcare providers.Appropriate footwear.Treatment of non ulcerative pathology
![Page 15: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/15.jpg)
Regular inspection and examination of the foot
• All diabetic patients should be examined at first presentation then at least once a year
• Patients with risk factors should be examined every 1-6 months
• Absent symptoms does not mean that the feet are healthy
• Examine the patient on lying down and standing up
• Shoe and socks should be inspected
![Page 16: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/16.jpg)
History
• Previous ulcer , amputation• Previous foot education• Bare-foot walking• Poor access to healthcare• Smokimg , alcohol• Nephropathy,Retinopathy• Hypertension• Ischemic heart disease
![Page 17: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/17.jpg)
Foot examination
1. Nails Thick
too long
ingrown
fungal infection
wrongly cut nails
![Page 18: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/18.jpg)
Foot Examination
2.Foot deformity:
![Page 19: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/19.jpg)
Foot Examination
2.Foot deformity: Toe deformity
• Hammer toeHammer toe• Claw toeClaw toe
![Page 20: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/20.jpg)
Toe Deformity:– Hammer Toe
• Increased pressure on 2ndmetatarsal head• Increased pressure on prox. IPJ• Increased pressure on distal IPJ• Increased pressure on apex• Increased pressure on nail fold
![Page 21: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/21.jpg)
Foot Examination
2.Foot deformity: Toe deformity
Forefoot deformity• Hallux valgusHallux valgus
• Hallux rigidusHallux rigidus
![Page 22: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/22.jpg)
Hallux Valgus
![Page 23: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/23.jpg)
Hallux Rigidus
Osteoarthritic Degeneration 1st MTP Joint
Limitation of Dorsiflexion
Overloading 2nd MTP Joint / 1st IPJoint
![Page 24: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/24.jpg)
Foot Examination
2. Foot deformity: Toe deformity
Forefoot deformity
Wholefoot DeformitiesWholefoot Deformities
• Pes Cavus - High arched footPes Cavus - High arched foot• Pes Planus - Flat footPes Planus - Flat foot• Charcot footCharcot foot
![Page 25: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/25.jpg)
Diagnosis of Acute Charcot Painless
Redness, swelling, and more than 2°C skin temperature difference when compared with the contralateral foot.
Dorsalis pedis pulses are often bounding.
The patient is afebrile unless a systemic infection is present.
![Page 26: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/26.jpg)
![Page 27: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/27.jpg)
Foot Examination
2.Foot deformity: Toe deformity
Forefoot deformity
Whole foot DeformitiesWhole foot Deformities
Prominent metatarsal headsProminent metatarsal heads
![Page 28: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/28.jpg)
Foot Examination
3.Skin condition:
Callus BunionsCallus Bunions Redness WarmthRedness Warmth Fissure DrynessFissure Dryness Swelling MacerationSwelling Maceration Fungal infectionFungal infection
![Page 29: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/29.jpg)
Callus
• Presence of callus is a significant marker for the development of foot ulceration
• The hyperkeratosis is a result of hypertrophy under the influence of intermittent compression .
• the callus is either a reaction to abnormal pressure or an abnormality of the area to handle normal pressure.
![Page 30: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/30.jpg)
Tenia Pedis
![Page 31: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/31.jpg)
Foot Examination
4.Vascular assessment:
History Intermitent claudicationIntermitent claudication
Rest painRest pain
Colour of the skin
Temperature gradient
![Page 32: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/32.jpg)
Foot Examination
4.Vascular assessment:
Pedal pulse Dorsalis pedisDorsalis pedis
Posterior tibialPosterior tibial
![Page 33: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/33.jpg)
Foot Examination
4.Vascular assessment:
Pedal pulse Dorsalis pedisDorsalis pedis
Posterior tibialPosterior tibial
Ankle Brachial Pressure Index
![Page 34: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/34.jpg)
Foot Examination
5. Neurological assessment:
![Page 35: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/35.jpg)
Neurologic assessmentNeurologic assessment
Temperature Temperature Vibration Sense Vibration Sense Pressure Sense Pressure Sense Light Touch Light Touch Proprioception Proprioception ReflexesReflexes
![Page 36: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/36.jpg)
Neurologic assessmentNeurologic assessment
![Page 37: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/37.jpg)
Neurologic assessmentNeurologic assessment
Temperature Temperature Vibration Sense Vibration Sense Pressure Pressure SenseSense Light Touch Light Touch Proprioception (Romberg’s Sign)Proprioception (Romberg’s Sign) Superficial Pain Superficial Pain ReflexesReflexes
![Page 38: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/38.jpg)
TEMPERATURE TESTINGTEMPERATURE TESTING
Two test tubes, hot/cold.Two test tubes, hot/cold. Therm-tipTherm-tip Subjective, crude testsSubjective, crude tests
![Page 39: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/39.jpg)
Neurologic assessmentNeurologic assessment
Temperature Temperature Vibration Sense Vibration Sense Pressure Pressure Sense Sense Light Touch Light Touch ProprioceptionProprioception Superficial Pain Superficial Pain ReflexesReflexes
![Page 40: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/40.jpg)
VIBRATION SENSEVIBRATION SENSE
![Page 41: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/41.jpg)
NEUROTHESIOMETERNEUROTHESIOMETER
![Page 42: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/42.jpg)
Neurologic assessmentNeurologic assessment
Temperature Temperature Vibration SenseVibration Sense Pressure Pressure Sense Sense Light Touch Light Touch Proprioception Proprioception Superficial Pain Superficial Pain ReflexesReflexes
![Page 43: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/43.jpg)
MONOFILAMENTSMONOFILAMENTS
10 gm Sites tested Technique Significance
![Page 44: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/44.jpg)
![Page 45: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/45.jpg)
Neurologic assessmentNeurologic assessment
Temeprature Temeprature Vibration Sense Vibration Sense PressurePressure Sense Sense Light Touch Light Touch ProprioceptionProprioception Superficial Pain Superficial Pain ReflexesReflexes
![Page 46: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/46.jpg)
LIGHT TOUCH TESTLIGHT TOUCH TEST
![Page 47: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/47.jpg)
Neurologic assessmentNeurologic assessment
Temperature Temperature Vibration Sense Vibration Sense Pressure Pressure Sense Sense Light Touch Light Touch ProprioceptionProprioception Superficial Pain Superficial Pain ReflexesReflexes
![Page 48: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/48.jpg)
PROPRIOCEPTION TESTPROPRIOCEPTION TEST
Tested by dorsiflexing Tested by dorsiflexing and plantarflexing the and plantarflexing the hallux. Can the patient hallux. Can the patient determine the position determine the position
of the hallux?of the hallux?
![Page 49: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/49.jpg)
Neurologic assessmentNeurologic assessment
Temperature Temperature Vibration Sense Vibration Sense Pressure Pressure Sense Sense Light Touch Light Touch Proprioception Proprioception Superficial Pain Superficial Pain ReflexesReflexes
![Page 50: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/50.jpg)
SUPERFICIAL PAIN TESTSUPERFICIAL PAIN TEST
![Page 51: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/51.jpg)
Neurologic assessmentNeurologic assessment
Temperature Temperature Vibration Sense Vibration Sense Pressure Pressure Sense Sense Light Touch Light Touch ProprioceptionProprioception Superficial Pain Superficial Pain ReflexesReflexes
![Page 52: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/52.jpg)
ANKLE REFLEXANKLE REFLEX
![Page 53: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/53.jpg)
Five cornerstones of the management of the diabetic foot
Regular inspection and examination of the foot.Identification of the foot at risk.Education of patient, family and healthcare providers.Appropriate footwear.Treatment of non ulcerative pathology
![Page 54: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/54.jpg)
Risk Categorization
![Page 55: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/55.jpg)
Risk categorization system
Category Risk profile Check-
up frequency
0 no sensory neuropathy once a year
1 sensory neuropathy once every 6
months
2 sensory neuropathy and signs of peripheral vascular disease and/or foot deformities.
once every 3 months
3 previous ulcer once every
month
![Page 56: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/56.jpg)
Five cornerstones of the management of the diabetic foot
Regular inspection and examination of the foot.Identification of the foot at risk.Education of patient, family and healthcare providers.Appropriate footwear.Treatment of non ulcerative pathology
![Page 57: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/57.jpg)
Five cornerstones of the management of the diabetic foot
Regular inspection and examination of the foot.Identification of the foot at risk.Education of patient, family and healthcare providers.Appropriate footwear.Treatment of non ulcerative pathology
![Page 58: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/58.jpg)
Five cornerstones of the management of the diabetic foot
Regular inspection and examination of the foot.Identification of the foot at risk.Education of patient, family and healthcare providers.Appropriate footwear.Treatment of non ulcerative pathology
![Page 59: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/59.jpg)
What is going on??
![Page 60: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/60.jpg)
Foot care team
• ??Podiatrists
• Orthotists.
• Diabetologists.
• Vascular Surgeon.
• Educators.
• Microbiologist.
![Page 61: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/61.jpg)
Ulcer assessment
1.Establish the ulcer's etiology2.Measure its size3.Establish its depth and involvement of deep
structures4.Examine it for purulent exudates, necrosis,
sinus tracts, and odor5.Assess the surrounding tissue for signs of
edema, cellulitis, abscess, and fluctuation6.Exclude systemic infection7.Perform a vascular evaluation. 8.The ability to gently probe through the ulcer to
bone has been shown to be highly predictive of osteomyelitis.
(should be recorded at base line and every subsequent visits ± digital photo)
![Page 62: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/62.jpg)
• A multidisciplinary approach
providing debridement, meticulous wound care, adequate vascular supply, metabolic control, antimicrobial treatment and relief of pressure (offloading) is essential in the treatment of foot ulcer.
![Page 63: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/63.jpg)
Dressing
Do not put anything on the ulcer that you wouldn’t put in your eye!!
No evidence from large trials
![Page 64: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/64.jpg)
Debridement
Sharp LarvalEnzymatic (Lytic)
Indication & Contraindication??
![Page 65: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/65.jpg)
Offloading
![Page 66: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/66.jpg)
Offlaoding
• What is meant by offloading
• Different offloading modalities
![Page 67: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/67.jpg)
Key Message• Of all late complications of diabetes, foot problems
are the most easily detectable and easily preventable.
• Relatively simple interventions can reduce
amputations by 50 - 80%. (Bakker et al 1994).
• Strategies aimed at preventing foot ulcers are cost effective and cost saving.
• Only champions willing to act are needed.
![Page 68: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/68.jpg)
Don’t Forget to take your copy!
![Page 69: Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal](https://reader035.vdocuments.us/reader035/viewer/2022062515/56649cda5503460f949a4cd6/html5/thumbnails/69.jpg)
Thanks for sharing!!!!Thanks for sharing!!!!