This presentation discusses diabetic foot complications. It begins with an overview of topics to be covered, including the concept of diabetic foot, its complications like ulcer, neuropathy and arthropathy, infections and amputations, and management through medical and physiotherapy approaches. Diabetic foot refers to any pathology resulting from diabetes and is caused by a triad of ischemia, neuropathy and infection. Complications include ulcers, neuropathy, arthropathy and infections, which can sometimes lead to amputation. The presentation discusses assessment, medications, footwear, bracing, exercises and other physiotherapy techniques for managing diabetic foot complications.

1. WELCOME TO OUR
PRESENTATION
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2. OUR PRESENTATION TOPICS
DIABETIC FOOT
Mithun Adhikari
----4th year student
Bangladesh health professions institute
Department of Physiotherapy
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3. OVERVIEW
 Concept of Diabetic Foot
 Complication of Diabetic Foot
 Diabetic Foot Ulcer
 Diabetic Neuropathy
 Diabetic Foot Arthropathy
 Diabetic infection & amputation
 Management
 Medical Management
 Physiotherapy Management 3

4. CONCEPT OF DIABETIC FOOT
Diabetic Foot is a foot that exhibits any pathology that results
directly from diabetes mellitus or chronic complication of
diabetes mellitus.
Complications in the diabetic foot are mostly caused by a triad
of ischemia, diabetic neuropathy, and infection.
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5. CONCEPT OF DIABETIC FOOT CONT…
Diabetic Foot is a foot that exhibits any pathology that results
directly from diabetes mellitus or chronic complication of
diabetes mellitus.
Complications in the diabetic foot are mostly caused by a
triad of ischemia, diabetic neuropathy, and infection.
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6. DIABETIC FOOT
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7. COMPLICATION OF DIABETIC FOOT
Presence of several characteristic diabetic foot
pathologies such as
 Diabetic foot ulcer
 Diabetic neuropathy
 Diabetic foot arthropathy
 Diabetic foot infections
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8. DIABETIC FOOT ULCER
Diabetic foot ulcer is a major complication of diabetes
mellitus. Wound healing is an innate mechanism of
action that works reliably most of the time. Key
feature of wound healing is stepwise repair of lost
extracellular matrix that forms the largest component
of the dermal skin layer.
But in some cases certain disorders or physiological
insult disturbs the wound healing process. diabetes
mellitus is one such metabolic disorder that impedes
the normal steps of the wound healing process.
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9. DIABETIC FOOT ULCER
Diabetic foot ulcer is a major complication of diabetes
mellitus. Wound healing is an innate mechanism of
action that works reliably most of the time. Key feature
of wound healing is stepwise repair of lost extracellular
matrix that forms the largest component of the dermal
skin layer.
But in some cases certain disorders or physiological
insult disturbs the wound healing process. diabetes
mellitus is one such metabolic disorder that impedes the
normal steps of the wound healing process.
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10. DIABETIC FOOT ULCER
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11. DIABETIC NEUROPATHY
Diabetic neuropathy is nerve damage that is caused by
diabetes.
Four types of diabetic neuropathy are available –
Peripheral Neuropathy
peripheral neuropathy is nerve damage that typically affects
the feet and legs and sometimes affects the hands and arms.
Autonomic Neuropathy
Autonomic neuropathy is damage to nerves that control the
internal organs. It can lead to problems with heart rate, blood
pressure, sex organs, sweat glands. 11

12. DIABETIC NEUROPATHY CONT…
Focal neuropathy
It is the condition in which typically have damage
to single nerves, most often the hand, head, torso,
and leg.
Proximal neuropathy
It is a rare and disabling type of nerve damage in
hip, buttock or thigh. It damage typically one side
of the body and may rarely spread to the other side.12

13. DIABETIC NEUROPATHY
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14. DIABETIC FOOT ARTHROPATHY
Diabetic foot arthropathy also known as charcot
foot. They may present with muscle weakness in the
feet, ankles, legs and hands. An awkward way of
walking(gait), highly arched or very flat feet.
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15. DIABETIC FOOT ARTHROPATHY
Diabetic foot arthropathy also known as charcot
foot. They may present with muscle weakness in
the feet, ankles, legs and hands. An awkward way
of walking(gait), highly arched or very flat feet.
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16. DIABETIC INFECTION & AMPUTATION
The most common sign is increased ulcer exudation rate.
Diabetic foot infection may lead to poor glycemic control.
There is a 50% delay in diagnosing deep foot infections in
diabetes patients because the infection markers in their
blood tests are found absent.
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17. DIABETIC INFECTION & AMPUTATION
In danger condition of diabetic foot infection, amputation is
very needed. After amputation, rehabilitation process is very
important.
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18. MEDICATIONS AND INSULIN
Metformin
 It works by improving the sensitivity of body
tissues to insulin, so that your body uses insulin
more effectively
Sulfonylureas
Meglitinides
Insulin therapy
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19. PROPER FOOTWEAR
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20. PHYSIOTHERAPY MANAGEMENT
To avoid tropic changes proper footwear is advised
To stabilized the unstable Ankle Joint braces are advised
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21. FOOT BRACE
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22. PHYSIOTHERAPY MANAGEMENT
To avoid tropic changes proper footwear is advised
To stabilized the unstable Ankle Joint braces are advised
To prevent contracture, passive stretching of the joint is
indicated
Active ROM exercise to mobilize the foot
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23. Patients should perform an aerobic exercise program 3-5
days per week and for 150 minutes per week at mid to
moderate intensity ( RPE 10-12 / 20 )
Walking (Outside or Inside in a treadmill
Ride bicycle
Ride stationary bicycles indoor
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24. ACTIVE ROM EXERCISE
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25. HOMECARE ADVICE:
Inspecting the feet
 Check for redness or soreness
Washing the feet
 Check temperature of mild warm water with
fingers for damaged nerves
Drying the feet
Moisturizing the skin
Toenails should be cut only when nails are soft 27

26. PROSTHETIC FOOT FOR AMPUTATION
PATIENT
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27. GAIT TRAINING
Training is given in the parallel bars
1. Standing balance on both the legs
2. Taking the body weights on both the legs
alternatively
3. With bilateral hand support, coordinated stepping
4. It is now progressed to single hand support
5. Sitting to standing
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28. REFERENCES:
 Boulton in Diabetes, 30;36 2002
 Singh, N. "Preventing Foot Ulcers in Patients With Diabetes".
JAMA. Retrieved 21 November 2013.
 International Working Group on the Diabetic Foot (2015)
 Selva Olid A, Solà I, Barajas-Nava LA, Gianneo OD, Bonfill
Cosp X, Lipsky BA (4 September 2015). "Systemic antibiotics
for treating diabetic foot infections". Cochrane Database of
Systematic Reviews.
 Dorresteijn JAN, Kriegsman DMW, Assendelft WJJ, Valk GD
(2014). "Patient education for preventing diabetic foot
ulceration". Cochrane Database of Systematic Reviews
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29. Arad Y, Fonseca V, Peters A, Vinik A (2011). Beyond
the Monofilament for the Insensate Diabetic Foot: A
systematic review of randomized trials to prevent the
occurrence of plantar foot ulcers in patients with
diabetes"
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