management of diabetic foot.pptx
TRANSCRIPT
DIABETIC FOOT CAREHABIB BAKRI BIN MAMAT
60004049
HOSPITAL SULTANAH NUR ZAHIRAH (HSNZ)
EMERGENCY DEPARTMENT – DR. MOHD LOTFI HAMZAH (HOD OF ED HSNZ)ORTHOPAEDIC DEPARTMENT – DR. HJ. AHMAD TAJUDDIN B. ABDULLAH (SPINE SURGEON OF HSNZ)
MEDICAL ELECTIVES
OUTLINES▪ Backgrounds
▪ Approach to a Patient with Diabetic Foot Problems.
▪ Diagnosis and Identification of Risk Factors▪ Diabetic Foot Ulcers▪ Diabetic Foot Infections▪ Diabetic Charcot’s Foot
▪ TIME principle of wound bed preparation
▪ Prevention
▪ Conclusion
BACKGROUNDThe foot manifestation of diabetes is well documented and potentially limb threatening when left untreated.
A healthy, intact diabetic foot is best maintained by consistent and recurrent preventive treatment strategy.
Diabetes is chronic problem and the incidence of diabetic foot complications increases with age and duration of the disease.
Diabetic patients at risk for foot lesions must be educated about the risk factors and the important of foot care.
The primary management goal for diabetic foot is to heal the ulcer as early as possible and prevent amputation.
Resolving diabetic foot problems and decreasing the recurrence rate can lower the probability of lower extremity amputation.
APPROACH TO A PATIENT WITH DIABETIC FOOT PROBLEMS
Diagnosis & Evaluation
History - General Hx - Foot Specific Hx
- Wound Hx
Physical Examination A. General
B. Local – Musculoskeletal,
Dermatological, Vascular, Neurological, Footwear
Investigations - Lab
Ix, Imaging, Vascular Ix, Neurological Ix, Assessment
of plantar foot pressures
DIAGNOSIS AND IDENTIFICATION OF RISK FACTORS
▪Diabetic Foot Ulcer
▪Diabetic Foot Infections
▪Diabetic Charcot’s Foot
DIABETIC FOOT ULCER▪ Lower extremity assessment▪ Vascular▪ Neurological▪ Musculoskeletal
▪ Ulcer examination▪ Clinical▪ Search for osteomyelitis▪ Cultures & sensitivity▪ Radiographs
▪ Treatment▪ Debridement▪ Wound care▪ Off loading▪ Infection treatment▪ Vascular management▪ Medical Rx of comorbidities▪ Surgical management▪ Reduce risk of recurrence▪ Prevention
DIABETIC FOOT INFECTIONS▪ Assessment into ▪ Non- limb threatening ▪ Limb threatening
▪ Treatment▪ Surgical treatment▪ Wound care▪ Antibiotic treatment▪ Hyperglycemia control▪ Correct electrolytes▪ Optimize comorbidities▪ Frequent reassessment of
response to treatment▪ If infection subsides but ulcer
persists, follow principles of diabetic ulcer treatment
▪ Prevention
DIABETIC CHARCOT’S FOOT▪ Assessment▪ Clinical▪ Investigations▪ To exclude osteomyelitis
▪ Treatment ▪ Immobilization and rest ▪ Protected weight bearing ▪ Surgery ▪ Prevention
TIME PRINCIPLE OF WOUND BED PREPARATION
Tissue non viable or defecient
Infection or inflammation
Moisture imbalance
Edge of wound non advancing or undermined
Defective matrix and cell debris
High bacterial counts or prolonged inflammation
Desiccation or excess fluid
Non-migrating keratinocytesNon-responsive wound cells
Debridement Antimicrobials Dressings compression
Biological agentsAdjunct therapiesDebridement
Restore wound base and ECM protein
Low bacterial counts and control inflammation
Restore cell migration, maceration avoided
Stimulate keratinocyte migration
Viable/vascularize wound bed
Reduced inflammation
Optimal moisture balance
Epithelialized wound
PREVENTION▪ All efforts must be made to prevent foot complications from occurring
in diabetics and this is done through a multidisciplinary approach.
▪ Aspects of a diabetic foot prevention program include:▪ Education - patient (daily foot inspection) and physician (current
concepts of foot management) ▪ Foot care - Regular podiatric visits▪ Therapeutic Shoes - to protect from injury▪ Reduction of plantar pressure (off-loading) - to reduce plantar
pressure▪ Surgery - prevention of recurrent ulcers
CONCLUSION▪ Diabetes Mellitus is a lifelong disease and diabetic foot complications
can be life threatening, physically incapacitating, costly to treat and result in extensive morbidity.
▪ Screening, proper evaluation, early identification and treatment of the ‘at risk foot’ can reduce complications.
▪ A multidisciplinary team approach to diabetic foot problems can save costs and reduce most foot complications and amputation rate.
▪ If we manage diabetic foot problems according to this guidelines, we may attain the objectives of preventing limb loss, mortality maintain the quality of life of the patient.
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