PDCI Core Kit 15 Early Detection and Prevention of Diabetic Foot Dr. Hendra Zufry

7/23/2019 PDCI Core Kit 15 Early Detection and Prevention of Diabetic Foot Dr. Hendra Zufry

http://slidepdf.com/reader/full/pdci-core-kit-15-early-detection-and-prevention-of-diabetic-foot-dr-hendra 1/46

Curriculum(VitaeA.(Personal(Iden5ty

B.(Educa5on&(Training((

C.(Organiza5on(



Early Detection and

Prevention of Diabetic Foot



Learning Objectives

• Identify risk factors and strategies for early

detection of diabetic foot

• Explain the pathophysiology and etiology ofdiabetic foot



People with Diabetes

Increased risk of hospitalized and infection

Have a 15 % life time risk of developing foot ulcer

Have 15 – 40 fold higher risk of leg amputation

Every 30 seconds a lower limb lost caused by diabetes

85 % of amputations are preceded by foot ulcer

Early detection can prevent 40-85 % lower limb amputation

Frykberg RG, et al. J Foot Ankle Surg, 2000

IDF , International Working Group on Diabetic Foot 2007





Outcome

(19) 44%

(11) 25%

(5) 12%

(3) 7%(5) 12%

n = 43 patients

Improved

Minor Amputation

Major Amputation

Died

Self request

discharge

no amputation amputation death

50 %15 %

35 %

Source:

Speaker Meeting

Kyoto Foot Meeting 2008Em Yunir, Kyoto Foot Meeting 2012

No amputation Amputation Death



Pathophysiology of Diabetic Foot



Risk Factors of Diabetic Foot

Peripheral neuropathy

Peripheral vascular disease ( PAD )

Foot Deformities/ biomecanic

History of ulcer or amputationNon suitable footwear

Lack of access to health care

services

Edmond M, 2006



Risk Factors

10/11/2015 Kyoto Foot Meeting 2010 9



Peripheral Neuropathy

1. Autonomic Neuropathy

2. Motor Neuropathy

3. Sensoric Neuropathy



Autonomic neuropathy

Decreased sweating

Dry skin

Decreased elasticity

Repetitive Shears &

Pressures

Callus/ Fissure

Ulcer



Thermal trauma by hot water

Ill fitting shoes

Thermal trauma in `bajaj`

• Loss protective sensation• Decreased of pain threshold

• Lack of temperature sensation and proprioseption

Sensoric neuropathy



kaki :

Small musclewasting/hypotrophy

foot deformities

bone prominent

Increased foot pressure

Ulcer

Somatic Motor Neuropathy



• Correlated with atherosclerosis

• A1c 1 % 26 % PAD

• More aggressive

• Narrowing vessel lumen … obstructive

• Distal tissue necrosis

Peripheral Arterial Disease



Normal FattyStreak

FibrousPlaque

Athero-scleroticPlaque

PlaqueRupture/Fissure &

Thrombosis

Clinically Silent

Increasing Age

Angina, TIA`s, PAD

IschemicStroke

MyocardialInfarction

Critical

LegIschemia

Cardiovascular Death

Macrocirculation



Assesment Test Significants Findings

Patients History Interview Previous foot ulceration

Previous amputation

Diabetic > 10 years

A1c > 7 %Impaired vision

Neuropatic symptoms

Claudicatio

Diabetic Foot Examination



Assesment Significant finding

Gross inspection Hammartoes

Claw toes

Halux valgus



Deformity

Prominent MTP I

Hammer toes

Claw toes Pes Cavus




Gross inspection Deformities, Corn, calluses, bunionCallus with ulcer

Prominent metatarsal head



Callus (1)

Callus + ulkusCallus




Dermatologic examination Dry skinAbsence of hair

Yellow or erythematous scale

Ulcer

Heal Ulcer




Dermatologic examination Interspace maserationMoist

Uhealing ulceration




Nail deformities Yellow, thickened nailIngrowing nail edge

Long or sharp nail



Assesment Test Significant finding

Screening forneuropathy

Semmes-Weinsteinmonofilamen 10 gram

Lack of perseption atone or more side




Screening forneuropathy

Tuning fork 128 Hz Negative of vibrationperception




VascularExamination

•Palpation of dorsalis

pedis and tibialis

posterior arteri

•Ankle Brachial Index

( ABI )

•Color doppler

•Decrease or absent

pulse

• ABI < 0.9 consistent

with PAD

M f h A kl B hi l I d (ABI)



Measurement of the Ankle – Brachial Index (ABI).

Source: American Heart Association



Interpreting the Ankle-Brachial pressure Index ( ABI )

ABI Interpreting

>1.2 Rigid or calcified vessels or both

0.9 – 1.1/1.2 Normal (or calcified)

<0.9 Ischaemia

<0.6 Severe ischaemia

Source: American Diabetes Association Cek nilai

ABI tertinggi versi ADA 2015



Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6

Normal High risk

Deformity

Nail abnormality

Dry skinHypotrophy

muscle

Ulcus

Ulcus at plantar

Neuropathy

CallusMuscle at the

bottom

Infection foot

Edema

Rash

InfectionOsteomyelitis

Systemic

symptoms

Necrosis/

gangren foot --,

cutis, subcutis

fascia, joint.

Irreversible

Extensive

necrosis, should

be treated with

amputation

Wagner Classification

linical Manifestation



5 Cornerstones of Foot Management

Footexamination

Classificationrisk factors

EducationAppropriate

footwear

Treatment before ulcer



Do:

1. Check and take a look your feet everyday

2. Always using footwear

3. Check your shoes before wearing

4. Wearing proper shoes5. Buy shoes in afternoon

6. Always wearing cotton socks

7. Wash your feet with smooth soap, dry it

8. Clipping nail horizontally

9. Check your feet to health care professional

regularly

10. Use moisturizing lotion regularly

Prevention Program



Summary

• Diabetic foot is one of chronic complications ofdiabetes

• Pathophysiology of diabetic foot ias very complex

• Slow healing process, risk for ulcus to be chronicand high incidence of amputation

• Holistic management is mandatory and involvingmultidisciplines

•

Majority of ulcus or injury in diabetic foot can beprevented with early detection and prevention athigh risk of foot



Skin (1)



Bulu kaki yang menipis Atrofi jaringan subkutan

Skin (2)



UlkusWarna kulit kaki kemerahan Tinea ( jamur )

Bullahiperpigentasi

Skin (3)



Skin (4)

Maserasi kulit padasela jari

Bullae (tangan)



Nail (1)

1. Structure :

- atrophy

- hypertrophy- fragile



Kuku(2)

2. Change of color

3. Abnormality of nail growth

4. Infection



Nail Abnormalities



Swelling



Halux valgus

Hammer toes

Claw toes Pes Cavus

Deformities





Case Studies



Clinical Features and Diagnosis?

Mention physical abnormalities on below



Mention physical abnormalities on below

picture



Documents

PDCI Core Kit 15 Early Detection and Prevention of Diabetic Foot Dr. Hendra Zufry