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Deformities inDiabetic Feet
Klaus Kirketerp-Møller, Consultant, Ph.d. stud
Copenhagen Wound Healing Center
Bispebjerg University Hospital, Denmark
Deformities
•Not Related to Diabetes •Bunion
•Hallux valgus
•Hallux rigidus
•Flat foot
•Hammer toes
•Mallet toes
Deformities
•Related to diabetes
Deformities
•Related to neuropathy •Hammer toes/mallet toes
•Prominent metatarsal heads
•Equinus feet
•Charcot
•Others
Treatment of Non-Diabetes Related Deformities
•Normal protocol
• No neuropathy
• Adequate perfusion
•Attenuated Protocol
• Neuropathy
• Adequate perfusion
”Compliance” is closely linked to neuropathy
The Attenuated Protocol
•Augmented fixation
•Augmented off-loading
•Prolonged off-loading
•Therapeutic footwear
•Crutches?
Deformities
•Related to neuropathy •Hammer toes/mallet toes
•Prominent metatarsal heads
•Equinus feet
•Charcot
•Others
The Imbalance theory
•The Neuropathy affects • Sensory fibers
• Altered sensation
• Pain Fibers
• Absent pain perception
• Neuropathic pain
• Proprioception
• Balance
• Motion coordination
• Temperature sensation
• Autonomic function
• Sweating
When to Suspect Neuropathy
•Professional approach
• Longstanding diabetes
• Alcohol ”overuse”
• Clinical examination
- Monofilament
- Vibration threshold
- Neuropad
• Nerve velocity
•Practical approach
• Present or previous foot
ulcer
• Deformity
• Clinical presentation of
- Dry skin
- Callosities
- Fissures
- Atrophy of fat or muscles
Toe Deformities
•Hallux rigidus
•Hallux valgus
•Hammertoes
•Mallet toes
•Deviations
•Hyperextension toes
Metatarsal Deformities
•Prominent metatarsal heads
• Dorsal subluxation of MTP
Joint
•Hallux valgus
•Spread-foot
Midfoot deformities
•Eversion deformity
•Flat-foot deformity
•Charcot deformity
Etiology
•Eversion deformity •Muscle imbalance
• Neuropathy
• Surgery
• Rupture
- Infection
- Inflammation
- Traumatic
Hindfoot Deformities
•Equinus deformity
• Fixed
• Redressable
Ankle deformity
•Traumatic
• Ankle fracture
•Charcot
How I work
Daily Living Activities
•Bying Shoes
• Appearence
• Appearence
• Appearence
• Function
• Fit
•Ordering Shoes
• Function and Fit
• Appearence
[email protected] UCM Lecture
EWMA 2016
Bremen
Where´s Wally?
EWMA UCM Lecture
EWMA 2016
Bremen
How I work
85 %
Examination
EWMA UCM Lecture
EWMA 2016
Bremen
The Story of Cuno
EWMA UCM Lecture
EWMA 2016
Bremen
Recapture
• Appearance
• Stigmata
• Pass the Examination
• Lack of recognition (Steps, Load)
[email protected] UCM Lecture
EWMA 2016
Bremen
Recapture
• Appearence
• Stigmata
• Pass the Examination
• Lack of recognition (Steps, Load)
• Lack of fear
[email protected] UCM Lecture
EWMA 2016
Bremen
The Anthropological Approach
Illness, Normality and Self-management: Diabetic Foot Ulcers and the Logic
of Choice
Signe Lindgaard Andersen & Vibeke Steffen
[email protected] UCM Lecture
EWMA 2016
Bremen
Discourse
Having DiabetesBeing a
person with Diabetes
[email protected] UCM Lecture
EWMA 2016
Bremen
Diabetic Patients Diabetics
1980-
Identity
Management
Three ”Typical” Cases
•Jytte
• The in-experienced
•Preben
• The experienced
•Mathias
• End- stage
•"Normally, I don’t have
foot ulcers"
•"I have a son and he gets
no food then"
•"If only I had listened
properly"
[email protected] UCM Lecture
EWMA 2016
Bremen
Recapture
• Appearence
• Stigmata
• Pass the Examination
• Lack of recognition (Steps, Load)
• Lack of fear
• Self-management
• ”Did I pass?”
• Guilt and Depression
[email protected] UCM Lecture
EWMA 2016
Bremen
EWMA UCM Lecture
EWMA 2016
Bremen
Now -go home and change..
Thank you for your attention.
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