diabetic foot neuropathy - digpdigp.ie/.../workshop-4-emily-haworth-diabetic-foot... · diabetic...
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![Page 1: Diabetic foot Neuropathy - DiGPdigp.ie/.../Workshop-4-Emily-Haworth-Diabetic-foot... · Diabetic foot Neuropathy EMILY HAWORTH, MSC POD MED, SCPI. SENIOR DIABETES PODIATRIST BGH](https://reader034.vdocuments.us/reader034/viewer/2022051512/602c228c34d931072411d8f2/html5/thumbnails/1.jpg)
Diabetic foot
NeuropathyEMILY HAWORTH, MSC POD MED, SCPI.
SENIOR DIABETES PODIATRIST BGH.
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The inability to feel pain, pressure, or
temperature contributes to 80%of
foot ulceration.
Ulceration preceeds amputation by
85%. Muller et al 2002.
Importance of recognising ,
diagnosing and managing DPN
is vital.
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Site of testing.Testing for LOPS.
Semmes Weinstein 10g monofilament, 85% sensitivity in detecting LOPS in 8 sites. ( Boulton et al 2008)
128 mhz tuning fork has same for 1 site.
Int National working group 2015 advice 3 sites .1st Hallux, ist met head and 5th met head
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How do we protect
these feet
Checking feet by health professionals.
Tighter glycaemic control.
Referral to Foot protection team in the community if feet intact .
Refer to the Hospital Podiatry team if ulceration present.
Intense health education for thepatient.
Advice to patient.
Check feet every day .
Footwear needs to be for high risk feet ,
Seam free, deep toe box, wide forefoot.
Apply emollient daily
Educate by giving live examples.
Use motivational interviewing.
Give clear instructions on who and how
to contact if they see a problem.
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Neuropathic ulceration
How would you manage this? Referral pathways, Not all wounds tell the truth
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Management of Diabetic neuropathic ulceration
Debridement, infection control, offloading, patient education
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Total contact cast
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Aircast boot
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Darco woundshoe
system
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Simple padding to
offload.
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Red, Hot, Swollen foot presentationCharacteristics.
Portal of entry?.
2 degrees hotter than contralateral limb .
Pain , pulses, neuropathic status
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Charcot arthropathy
Charcot is a neuroathropathic process with osteoporosis, fracture, acute inflammation and disorganisation of foot architecture ( SIGN 2004)
Lops and proprioception loss = lig laxity, instability, trauma, weight bearing changes and more trauma. Acute inflammatory response and vasomotor changes altering blood flow lead to bone reabsorption .
Followed by hypertrophic repair.
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Life threatening,
devastating, clinical
emergency
Neuropathic. Vascular supply good, 2 to 8 D hotter than other limb.
Eliminate infection
X ray\ MRI\ Bloods\ bone scan?
Complicated by presence of ulcer?
Complete immobility, TCC,
Bisphosphonates??
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Case studiesTaken with permission from patients In BGH Diabetic Podiatry clinic.
DANleads to fissuring
Risk of ulceration and infection
Dressing allergy.
Pruritis = Wound
Limb threatening Profound Neuropathy .
Osteomyelitis.
Challenging patient
Self trauma
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In Summary
Check feet
Risk assess
Clear referral
pathwaysEducation
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Thank you