Diabetic Foot Lecture 2010

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Lecture on Diabetic Foot Complications

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Diabetic Foot Lecture 2010

  1. 1. Diabetic Foot Complications – Current treatments and advanced therapies in treating the diabetic foot Don Pelto, DPM Central Massachusetts Podiatry, PC Worcester, MA
  2. 2. Objectives • Participants will understand incidence and economic impact of diabetic foot infections • Participants will define the risk factors leading to diabetic foot infections • Participants will learn to diagnose an “at risk” diabetic foot • Participants will understand current treatments and advanced therapies in the standard of care/treatment for diabetic foot ulcers
  3. 3. Case Study M.S. • CC: Chronic ulceration right foot • PMH: DM-2, HTN, Restless Leg Syndrome • PSH: Unremarkable • NKDA • Meds: Glucophage, Humalog, Miripex, Lisinopril
  4. 4. Diabetic Foot Ulcers • One of the most common complications of diabetes • Annual incidence 1% to 4%1-2 • Lifetime risk 15% to 25%3-4 • ~15% of diabetic foot ulcers result in lower extremity amputation3,5 • ~85% of lower limb amputations in patients with diabetes are preceded by ulceration6-7 • Peripheral neuropathy is a major contributing factor in diabetic foot ulcers1-7 1. Reiber and Ledoux. In The Evidence Base for Diabetes Care. 4. Boulton et al. Lancet. 2005;366:1719. Williams et al, eds. Hoboken, NJ: John Wiley & Sons; 5. Ramsey et al. Diabetes Care 1999;22:382. 2002:641–665. 6. Pecoraro et al. Diabetes Care. 1990;13:513. 2. Boulton et al. NEJM. 2004;351:48. 7. Apelqvist and Larsson. Diabetes Metab Res Rev. 3. Sanders. J Am Podiatry Med Assoc. 1994;84:322. 2000:16:S75.
  5. 5. Costs to Treat a Diabetic Foot Ulcer Over a 2-Year Period Following Detection Ramsey et al. Diabetes Care. 1999;22:382. Cost analyses based on percent change in the medical component of the US consumer price index.
  6. 6. 5-Year Mortality Rates Armstrong DG, Wrobel J, Robbins JM. Guest Editorial: are diabetes-related wounds and amputations worse than cancer? Int Wound J. 2007;4(4):286–287
  7. 7. The Diabetic Foot – Risk Factors The Comprehensive Diabetic Foot Exam • Dermatological Considerations • Nerve Considerations • Osseous Considerations • Vascular Considerations • Shoegear Considerations Pinzur et al. Foot & Ankle International. 2005;26:1:113-119. Guidelines for diabetic footcare. Valk GD, Kriegsman DMW, Assendelft WJJ. Patient education for preventing diabetic foot ulceration. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD001488. DOI: 10.1002/14651858.CD001488.pub2.
  8. 8. Current and Advanced Treatments for Wounds
  9. 9. Dermatological Considerations • Dry Skin • Fungal Infection • Callus • Interdigital lesions • Ingrown Nail • Ulceration
  10. 10. Dermatological Considerations • Dry Skin • Fungal Infection • Callus • Interdigital lesions • Ingrown Nail • Ulceration
  11. 11. Dermatological Considerations • Dry Skin • Fungal Infection • Callus • Interdigital lesions • Ingrown Nail • Ulceration
  12. 12. Dermatological Considerations • Dry Skin • Fungal Infection • Callus • Interdigital lesions • Ingrown Nail • Ulceration
  13. 13. Dermatological Considerations • Dry Skin • Fungal Infection • Callus • Interdigital lesions • Ingrown Nail • Ulceration
  14. 14. Dermatological Considerations • Dry Skin • Fungal Infection • Callus • Interdigital lesions • Ingrown Nail • Ulceration
  15. 15. Dermatological Considerations • Dry Skin • Fungal Infection • Callus • Interdigital lesions • Ingrown Nail • Ulceration
  16. 16. Dermatological Considerations • Dry Skin • Fungal Infection • Callus • Interdigital lesions • Ingrown Nail • Ulceration
  17. 17. Dermatological Considerations • Dry Skin • Fungal Infection • Callus • Interdigital lesions • Ingrown Nail • Ulceration Spencer SA. Pressure relieving interventions for preventing and treating diabetic foot ulcers. Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD002302. DOI: 10.1002/14651858.CD002302.
  18. 18. Dermatological Treatments • Callus – Diabetic shoes • Ulceration – VAC – Debridement – Dermal Skin Substitute – Platelet Rich Plasma Spencer SA. Pressure relieving interventions for preventing and treating diabetic foot ulcers. Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD002302. DOI: 10.1002/14651858.CD002302.
  19. 19. Dermatological Treatments • Callus – Diabetic shoes • Ulceration – VAC – Debridement – Dermal Skin Substitute – Platelet Rich Plasma Ubbink DT, Westerbos SJ, Evans D, Land L, Vermeulen H. Topical negative pressure for treating chronic wounds. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD001898. DOI: 10.1002/14651858.CD001898.pub2.
  20. 20. Dermatological Treatments • Callus – Diabetic shoes • Ulceration – VAC – Debridement – Dermal Skin Substitute – Platelet Rich Plasma Edwards J, Stapley S. Debridement of diabetic foot ulcers. Cochrane Database of Systematic Reviews 2010, Issue 1.
  21. 21. Dermatological Treatments • Callus – Diabetic shoes • Ulceration – VAC – Debridement – Dermal Skin Substitute – Platelet Rich Plasma
  22. 22. Dermatological Treatments • Callus – Diabetic shoes • Ulceration – VAC – Debridement – Dermal Skin Substitute – Platelet Rich Plasma
  23. 23. Dermatological Treatments • Callus – Diabetic shoes • Ulceration – VAC – Debridement – Dermal Skin Substitute – Platelet Rich Plasma
  24. 24. Nerve Considerations • Neuropathy • Semmes Weinstein 5.07 monofilament (10g) • EMG and NCV
  25. 25. Nerve Treatments • Neuropathy – Medication Oral – Topical Medication – ENFB (Epidermal Nerve Fiber Biopsy)
  26. 26. Musculoskeletal Considerations • Foot Deformities • Plantar Pressure • Charcot Joint
  27. 27. Musculoskeletal Considerations • Foot Deformities • Plantar Pressure • Charcot Joint
  28. 28. Musculoskeletal Considerations • Foot Deformities • Gait Evaluation • Plantar Pressure • Charcot Joint
  29. 29. Musculoskeletal Treatments • Foot Deformities – Preventative foot surgery
  30. 30. Vascular Considerations • Pulses • Capillary filling time • Color changes • Edema • Temperature
  31. 31. Vascular Considerations • Pulses – Revascularization – Silverhawk – Vascular flaps
  32. 32. Shoegear Considerations • Type of shoe • Fit • Lining Wear • Insoles, Orthoses • Socks
  33. 33. Shoegear Modifications • Diabetic extra-depth shoes • Diabetic socks • Multi-density inserts
  34. 34. Thank You Don Pelto, DPM Central Massachusetts Podiatry, PC Worcester, MA 508.757.4003 don@worcesterfootcare.com

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