DefinitionWHO• The foot of a Diabetic Patient that has thepotential risk of pathologic consequencesincluding infection, ulceration and/ordestruction of deep tissues associated withneurologic abnormalities, various degreesof peripheral vascular disease and/ormetabolic complications of diabetes in thelower limb.
DefinitionAny foot pathology that results from Diabetesor its long-term complications(Boulton. 2002). Diabetes, 30 : 36, 2002
Epidemiology• WHO estimates approx 60,000 persons inT&T were diabetic in 2000• Projected increase to 125,000 by 2030• MOH estimates 1 in 5 adults are diabetic;as much as 175,000• 450 children with Type 1 DM• More prevalent in the East Indiancommunity, but 33% of African attendeesof the public health services are bothDiabetic and Hypertensive• Cause for about 25% Hospital Admissions
Epidemiology• More than 450 non traumatic lower limbamputations in 2010• DM foot problems account for 14% ofadmissions, 29% of bed occupancy• 50% of persons who had lower limbamputations develop depression; 20% diewithin 2 years• V Naraynsingh et al - 822 clinic patientswho had amputations between 2000-2004reviewed; 515 (80%) due to DM
Inspection• Corns and Calluses• Nails: Thickened or Atrophic, Ingrown,Colour of nail bed, Discharge, Fungalinfections• Oedema: poor fitting shoes, impedeshealingIndicator of CV, Renal status, venousinsufficiency, infection, Gout, Trauma,DVT, lymphoedema and many more
Foot Pressures• Plantar pressure measurement devices• Ink and paper
Classification• University of Texas Wound ClassificationSystem of Diabetic Foot Ulcers• Wagner• Edmonds
Edmonds Classification• Based on natural progression• Stage 1: Normal or Low Risk Foot• Stage 2: High-Risk Foot• Stage 3: Ulcerated Foot• Stage 4: Infected Foot• Stage 5: Necrotic Foot• Stage 6: Unsalvageable Foot
Edmonds Classification• Stage 1 – The foot is not at riskSensation and pulses goodNo deformities, calluses or swelling• Stage 2 – One or more risk factors forulcerationNeuropathy and Ischaemia are themain risk factorsDeformity, oedema and callus may notlead to ulceration unless one or both of themain risk factors are present
Edmonds Classification• Stage 3 – Skin breakdown occurs usuallyas an ulcer, but injuries such as grazes,bruises and blisters can eventuallybecome ulcers• Stage 4 – Infection can complicate boththe neuropathic and ischaemic foot• Stage 5 – Necrosis can further lead totissue destruction• Stage 6 – The foot cannot be saved
Edmonds ClassificationExceptions to this classification include• Charcot’s foot• Neuropathic fractures• Painful neuropathy
Management• Regular inspection and examination• Multidisciplinary team• Patient education• Assess risk of foot• Non ulcer pathology• Ulcers and related pathology
Foot Care• Daily Routine and Inspection• Between toes and below foot• Nail Care: trim wet, straight across, properclippers (NO KNIVES)• Skin Care: Moisture, Callus• Footwear: Proper fit, clean• Avoid excessive heat (Radiators, Hotwater, hot pitch)• Avoid OTC Corn/Callus medications• NEVER WALK BAREFOOT
Non Ulcer Pathology• Calluses & Nails – Podiatrist• Skin pathology• Foot deformities – Surgical / Orthopedicconsult
Ulcer Pathology• Treat the Cause(s) and co-morbid factors• Psychosocial Factors• Relief of mechanical pressure and protectulcer from stress• Local Wound Care• Treatment of Infection: Abx (BroadSpectrum, multiple), Drainage,Debridement• Moisture control: Dressings• Outpatient or Inpatient Care
References1. Edmonds ME, Foster AVM, Sanders LJ.A Practical Manual of Diabetic Foot Care2nd Ed. Blackwell Publishing 20082. Radwan M. The Diabetic Foot: AnOverview [Internet] cited 1st June 2012Available from:www.mansdf.edu.eg/Videos_presentations/DF-overview.pdf3. National Institute of Health. Feet can lasta Lifetime NIH and CDC. 2010
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