Diabetic Foot Care Guide for Prevention and Management
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Diabetic foot and Foot care Dr Joel Arudchelvam Definition Prevalence Teaching Hospital Anuradhapura [THA] High risk foot Neuropathy Pathogenesis of neuropathy Charcot foot Testing for neuropathy Local Ulcer care
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Diabetic Foot Care Guide for Prevention and Management
- 1. Diabetic foot and Foot care Dr Joel Arudchelvam MBBS (COL), MD (SUR). MRCS (ENG), FCSSL Consultant Vascular and Transplant Surgeon, Senior lecturer, department of Surgery, faculty of medicine, University of Colombo.
- 2. Diabetic foot Infection, ulceration or destruction tissues and bones with associated neuropathy and occlusive arterial disease in a patient with DM ( WHO definition)
- 3. Diabetic mellitus ▪ Sri Lanka ▪ In 2005 - diabetes mellitus � 14.2 % males � 13.5 % females
- 4. Diabetic foot ▪ Teaching Hospital Anuradhapura [THA] ▪ 100 patients ▪ 81 [81%] males ▪ mean age - 67.6 years ▪ Diabetes mellitus - 65 [65%] Arudchelvam, J. and De Soyza, M., 2022. Pattern of occlusive disease in lower extremity arteries in patients qualifying for revascularization in a North Central Province tertiary care centre in Sri Lanka. Sri Lanka Journal of Surgery, 40(2), p.20- 23.DOI: https://doi.org/10.4038/sljs.v40i2.8794
- 5. Diabetic foot ▪ University of Colombo ▪ Diabetes mellitus - 80%
- 6. Diabetic foot ▪ 4% -10% foot ulcer risk in DM ▪ 40% - 60% of all lower limb amputation ▪ 85% of amputation are preceded by foot ulcer
- 7. Diabetic foot ▪ Neuropathy ▪ Ischemia ▪ Infection ▪ Ulcer ▪ Bone destruction
- 8. High risk foot • History: Previous ulcer/lower extremity amputation, claudication • Absence of pedal pulses • Loss of protective sensation
- 9. Neuropathy ▪ Prevalence � 7% within 1 year of diagnosis ▪ 50% >25 years
- 10. Neuropathy • Increased risk for: Foot ulceration amputation Neuropathic pain Significant morbidity Usage of resources
- 11. Pathogenesis of neuropathy ▪ Progressive nerve fiber loss ▪ Mechanisms � Polyol pathway – hyperglycaemia - glucose to sorbitol � Advanced glycation end products (AGEs)
- 12. Neuropathy ▪ Sensory – Glove and stocking type ▪ Motor ▪ Autonomic
- 15. Ischemia ▪ Increased atherosclerosis ▪ Vascular disease � Ulcer � Gangrene
- 16. Ulcer ▪ In distal part of limb (forefoot or toes) ▪ Dry ▪ painful
- 17. Gangrene ▪ Death of tissue with infection � Dry – infection is limited to dead tissue and the margins � Wet - infection extends up
- 20. Charcot foot ▪ Due to reduced pain sensation and proprioception ▪ Resulting in � Fracture � joint destructions � Collapse of the arch of the foot � Inflammation ar
- 22. Osteomyelitis
- 23. Testing for neuropathy ▪ Pressure perception � Semmes-Weinstein 10 gram monofilament ▪ Vibration perception: � 128 Hz tuning fork
- 26. Prevention and management Patient education
- 27. Neuropathy - off loading
- 28. Nail cutting
- 29. Foot wear
- 30. Foot wear
- 31. Local Ulcer care ∙ Wound toilet o Process of removal of slough, dead tissue, foreign bodies and draining pus. o Following a wound toilet the wound base is made suitable for future granulation and epithelialisation.
- 35. Detection of ischemia and Revascularisation
- 36. Bypass
- 38. Avoid • Do not apply gauze bandage tightly around limbs, digits – causes ischaemia • Use – plaster , crepe instead
- 39. Summary ▪ Diabetes mellitus is a leading cause of limb loss ▪ Identification of high risk foot and prevention of ulcers is the mainstay of management
- 40. Thank You