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DIBETIC FOOT ULCER
ETIO-PATHOGENESIS & MANAGEMENTDR.ARUN BAL
S.L.RAHEJA HOSPITAL
METHOD OF OFF-LOADING
• BEDREST• CRUCTHES• WHEELCHAIR• SPECIAL FOOTWEAR• CONTACT CASTING
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
• OFF LOADING OF AFFECTED FOOT
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
SURGERY FOR DIABETIC FOOT ULCER
• PROPHYLACTIC• THERAPEUTIC
PRPHYLACTIC SURGERY FOR DIABETIC FOOT ULCER
• METATARSAL OSTEOTOMY• METATARSAL HEAD RESECTION• SESMOIDECTOMY• DIGITAL ARTHROPLASTY• BUNIONECTOMY• LOCAL FLAPS