dibetic foot ulcer etio-pathogenesis & management dr.arun bal s.l.raheja hospital
TRANSCRIPT
MECHANISM OF INJURY
• DIRECT PENETRATION OF SKIN
• SMALL AMOUNT OF FORCE SUSTAINED OVER A PERIOD OF TIME
• MODERATE AMOUNT OF REPATATIVE FORCE
INDICATION OF WORSENING INFECTION
• INCREASED DRAINAGE
• INCREASED ERYTHEMA
• SUDDEN INCREASE IN PAIN
• INCREASED WARMTH
• FOUL ODOUR
• LYMPHANGITIS
INDICATION OF WORSENING INFECTION(CONT)
• INCREASED BLOOD GLUCOSE LEVEL
• INCREASED WBC LEVEL
• INCREASED E.S.R
• REDUCED QUADRICEPS ACTION
• PERSISTANT ANOREXIA
• HIGH SERUM CREATININE
WHAT CAUSES HIGH PLANTAR PRESSURE?
• DISPLACEMENT OF METATARSAL CUSHION DISTALLY
• NON ENZYMATIC GLYCOLISATION
• LIMITATION OF MOVEMENT OF 1ST MTP JOINT
• REDUCED ELASTICITY
WHAT CAUSES HIGH PLANTAR PRESSURE?
• DECREASED SUBTALAR JOINT MOVEMENT
• EXCESSIVE PLANTAR KERATOSIS
• THICKENING OF SESMOID
• ADHESIONS & SCAR TISSUE
HOW DOES FOOT INJURY OCCUR?
• PEAK PLANTAR PRESSURE:1340kPa
• SYSTOLIC BP 120 mm OF H:15 kPa
• CAPILLARY PRESSURE :6 kPa
• DELAYED/ABSENT RECOVERY FROM ISCHAEMIA
• DELAYED/ABSENT RECOVERY OF NORMAL TISSUE OXYGEN CONC.
HOW DOES FOOT INJRY OCCUR?
• REPATATIVE MODERATE FORCE
• INFLAMMATION
• ERYTHEMA AND WARMTH
• COLLECTION OF EXUDATE
• BLISTER FORMATION
• BREAKDOWN OF SKIN --- ULCER
NEED FOR PROMPT TREATMENT OF FOOT ULCER• 85% OF DIABETIC FOOT
AMPUTATIONS ARE DUE TO INADEQUATELY TREATED FOOT ULCER
• 30-50% AMPUTEES REQUIRE CONTRALATERAL AMPUTATION IN 3 YEARS
NEED FOR PROMPT TREATMENT IF FOOT ULCER
• 10% MORTALITY IN THREE YEARS IN AMPUTEES
• ECONOMIC LOSS TO FAMILY AND SOCIETY
• 22% REQUIRE IPSILATERAL HIGHER AMPUTATION
FOOT ULCER ASSESSMENT
• PERIWOUND ERYTHEMA
• PERIWOUND ODEMA
• WOUND PURULENCE
• WOUND FIBRIN
• LIMB PITTING ODEMA
• LIMB BRAWNY ODEMA
FOOT ULCER ASSESSMENT
• WOUND GRANULATION
• VASCULAR STATUS
• WOUND MEASUREMENT
• OSTEOMYLITIS & TENOSYNOVITIS
MECHANISM OF INJURY IN DIABETIC FOOT
• NORMAL STRESS
• SHEAR STRESS
• FATIGUE
• STRESS CONCENTRATION
• ELATICITY
PRIMARY TREATMENT OF DIABETIC FOOT ULCER
• EVALUATION
• METABOLIC CONTROL
• DEBRIDEMENT
• BACTERIAL CULTURE
PRIMARY TREATMENT OF DIABETIC FOOT ULCER
• PARENTERAL ANTIBIOTICS
• OFF LOADING OF AFFECTED FOOT
• REVASCULARIZATION
• CORRECT FOOTWEAR
OBJECTIVES OF DIABETIC FOOT WEAR
• REDUCTION OF EXCESSIVE PLANTAR PRESSURE
• REDUCTION OF SHOCK
• REDUCTION OF SHEAR
• ACCOMODATION OF DEFORMITY
• STABALIZATION OF DEFORMITY
• LIMITATION OF JOINT MOVEMENT
OBJECTIVES OF DIABETIC FOOTWEAR
• WIDE TOEBOX• EXTRA DEPTH• SOFT UPPERS• MCR/PLASTAZOAT INSOLE• INSOLE WING PAD• ORTHOWDGE CORRECTION• WELL FITTING SOCKS