Intervensi Ortotik Prostetik Pada Diabetik Foot

IOPI Konferense Solo 2010Markku Ripatti

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Diabetes

Background summary

Causes, Symptoms,

Blood Sugar, Nutrition,

Complications, Treatments,

Prevention

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Diabetes and Foot problems

Diabetes and foot problems go hand and hand.  High levels of sugar damages nerves and arteries.

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Neuropathy and poor blood flow two main problems in diabetes

Neuropathy - nerve damage Causes are high blood sugar levels and poor blood circulation.

Lost of sensation and may have difficulty of using muscles.

Muscles may become weakened and loose functionality

Too much pressure on one part of the foot

Cause blisters and sores develop.

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Neuropathy and poor blood flow two main problems in diabetes

If not aware of foot injuries, then the injuries will go untreated and even small injuries can lead to a infection.

Estimated 10% of diabetics develop potentially dangerous foot ulcers as a result of nerve damage that masked smaller injuries.

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Neuropathy and poor blood flowtwo main foot problems in

diabetes:Poor blood flow - peripheral vascular disease

Healing of cuts and infections is not good because oxygen-rich blood cannot reach the area of infection efficiently

If infection goes for a prolonged amount of time without treatment or proper blood flow to the area, gangrene may develop

Amputation is the most common treatment for gangrene.

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Care of Lower Extremities

Numbness or Lack of Sensation in limbs (neuropathy), and/or Poor Circulation

Neuropathy means that may not be able to feel hot or cold, or pain from an injury to protect the foot or stump.

Not notice injury immediately – so a small problem like a small stone in a shoe or an ill-fitting prosthesis - if unnoticed - can lead to an ulcer.

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Common foot problems common among diabetes

Athlete's Foot , Blisters, Bunions,

Calluses, Corns, Dry Skin,

Foot Ulcers, Fungal Infections,

Ingrown Toenails, ...

Diabetes team approach:doctor, nurse, podiatrist, OP,...

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Footwear Proper footwear is important.

Shoes have to provide enough cushioning and comfort; good pressure distribution.

Shoes have to fit well; they have to be wide enough across the toes and do not restrict circulation.

Shoes have to at the right heel height for the alignment of the prosthesis, and should be replaced when become worn.

Use of seam-free socks will help improve circulation.

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Orthotic care Orthotist can design custom-fitting shoes to

prevent pressure areas from developing, or

Other devices, such as a patellar tendon bearing knee brace, to relieve pressures on the foot.

Or make an comfortable insole.

Create relieve on pressure areas

Follow biomechanics

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Prosthetic care Socket is the most important!

Socket has to fit well and not restrict circulation.

Flexible total contact sockets are good for amputees with diabetes, since they reduce discomfort and swelling in the stump.

Silicone and urethane gel sockets and liners can make the prosthesis comfortable to wear.

The layer of cushioning provide help to reduce skin irritations and help amputee to tolerate forces within a socket.

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Prosthetic use

Lightweight prosthesis means that less energy expenditure during walking.

Choosing the prosthetic foot to be appropriate. Elastic keel feet are comfortable, soft to walk.

Having a ”good gait” facilitates an active lifestyle.

Check if there are any bad habits or gait deviations which can be corrected.

Walking should go as well as possible, and not put any additional strain on residual limb or sound limb.

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Self-check /-care Make sure that also stump skin is clean and dry, and no pressure

points caused by socket and stump socks or liners.

Check feet daily to prevent bacteria from growing.

Handy to use diabetic foot care kits, which contain mirror to see the underside of foot and foot-brush to apply medication to hard-to-reach areas.

Trim toenails straight across

see a specialist (like podiatrist)

for treating calluses and bunions.

Always wear your prosthesis or mobility aid

Balance food, physical activity and medication

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Summary Diabetes and foot problems

Neuropathy

Peripheral vascular disease

Lack of sensation

Diabetes team

Foot wear

Orthotic care

Prosthetic care

Self-check / -care

Two thirds of amputation in people with diabetes can be prevented by proper foot care!

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Thank you Terima kasih