Diagnosis and Management of the Diabetic Foot   Don Pelto, DPM Central Massachusetts Podiatry, PC Worcester, Massachusetts
Diabetic Foot Ulcers <ul><li>One of the most common complications of diabetes </li></ul><ul><li>Annual incidence 1% to 4% ...
Costs to Treat a Diabetic Foot Ulcer  Over a 2-Year Period Following Detection Ramsey et al. Diabetes Care. 1999;22:382. C...
5-Year Mortality Rates Armstrong DG, Wrobel J, Robbins JM. Guest Editorial: are diabetes-related wounds  and amputations w...
Patient SM
Patient SM
Patient SM – 4 Months
Patient SM – 9 Months
Patient SM – 12 Months
Diabetic Ulcer <ul><li>4 Reasons Why Won’t Heal </li></ul><ul><ul><li>High Blood Sugar/Nutrition </li></ul></ul><ul><ul><l...
Comprehensive Diabetic Foot Examination (CDFE) <ul><li>Fasting BS, A1C </li></ul><ul><li>PMH, PSH, ROS, Meds </li></ul><ul...
Comprehensive Diabetic Foot Examination (CDFE)
Diabetic Shoes – Preventing Ulcers Most patient’s with Diabetes Qualify for a pair of Diabetic Shoes each year. <ul><ul><l...
Diabetic Footcare Recommendations <ul><li>Yearly  Comprehensive Diabetic Foot Examination by a podiatrist </li></ul><ul><l...
 
 
 
 
 
 
 
 
 
 
 
 
Patient PF – May 2009
Patient PF – May 2009
Patient PF – February 2011
 
 
 
 
 
 
 
 
  Thank You Don Pelto, DPM Central Massachusetts Podiatry, PC Worcester, MA [email_address] (508) 757-4003
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Unimed Presentation - Dr. Donald Pelto

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Unimed Presentation - Dr. Donald Pelto

  1. 1. Diagnosis and Management of the Diabetic Foot Don Pelto, DPM Central Massachusetts Podiatry, PC Worcester, Massachusetts
  2. 2. Diabetic Foot Ulcers <ul><li>One of the most common complications of diabetes </li></ul><ul><li>Annual incidence 1% to 4% 1-2 </li></ul><ul><li>Lifetime risk 15% to 25% 3-4 </li></ul><ul><li>~15% of diabetic foot ulcers result in lower extremity amputation 3,5 </li></ul><ul><li>~85% of lower limb amputations in patients with diabetes are preceded by ulceration 6-7 </li></ul><ul><li>Peripheral neuropathy is a major contributing factor in diabetic foot ulcers 1-7 </li></ul>1. Reiber and Ledoux. In The Evidence Base for Diabetes Care. Williams et al, eds. Hoboken, NJ: John Wiley & Sons; 2002:641–665. 2. Boulton et al. NEJM. 2004;351:48. 3. Sanders. J Am Podiatry Med Assoc. 1994;84:322. 4. Boulton et al. Lancet. 2005;366:1719. 5. Ramsey et al. Diabetes Care 1999;22:382. 6. Pecoraro et al. Diabetes Care. 1990;13:513. 7. Apelqvist and Larsson. Diabetes Metab Res Rev. 2000:16:S75.
  3. 3. 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.
  4. 4. 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
  5. 5. Patient SM
  6. 6. Patient SM
  7. 7. Patient SM – 4 Months
  8. 8. Patient SM – 9 Months
  9. 9. Patient SM – 12 Months
  10. 10. Diabetic Ulcer <ul><li>4 Reasons Why Won’t Heal </li></ul><ul><ul><li>High Blood Sugar/Nutrition </li></ul></ul><ul><ul><li>Poor Circulation, Edema (PAD) </li></ul></ul><ul><ul><li>Deeper Infection </li></ul></ul><ul><ul><li>Walking on Wound (Neuropathy) </li></ul></ul>
  11. 11. Comprehensive Diabetic Foot Examination (CDFE) <ul><li>Fasting BS, A1C </li></ul><ul><li>PMH, PSH, ROS, Meds </li></ul><ul><li>Orthopedic </li></ul><ul><li>Dermatological </li></ul><ul><li>Vascular </li></ul><ul><li>Neurological </li></ul><ul><li>Shoe Evaluation </li></ul><ul><li>Education </li></ul>
  12. 12. Comprehensive Diabetic Foot Examination (CDFE)
  13. 13. Diabetic Shoes – Preventing Ulcers Most patient’s with Diabetes Qualify for a pair of Diabetic Shoes each year. <ul><ul><li>Partial/Complete Amputation </li></ul></ul><ul><ul><li>Previous Ulceration </li></ul></ul><ul><ul><li>Pre-Ulcerative Callus </li></ul></ul><ul><ul><li>Neuropathy with Callus </li></ul></ul><ul><ul><li>Poor Circulation </li></ul></ul><ul><ul><li>Foot Deformity </li></ul></ul>
  14. 14. Diabetic Footcare Recommendations <ul><li>Yearly Comprehensive Diabetic Foot Examination by a podiatrist </li></ul><ul><li>Yearly Diabetic Footwear with inserts changed every 4 months </li></ul><ul><li>2-3 Months - Routine footcare based on symptoms </li></ul><ul><li>Daily foot evaluation by patient of family member </li></ul>
  15. 27. Patient PF – May 2009
  16. 28. Patient PF – May 2009
  17. 29. Patient PF – February 2011
  18. 38. Thank You Don Pelto, DPM Central Massachusetts Podiatry, PC Worcester, MA [email_address] (508) 757-4003

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