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