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The role of the podiatrist

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The role of the podiatrist

  1. 1. THE ROLE OF THE PODIATRIST IN THE CARE OF THE DIABETIC FOOT By Zoe Boulton
  2. 2. Contents       Assessment of the diabetic foot Features of ulcerations Debridement Dressings Biomechanics Offloading
  3. 3. General Role of the Podiatrist      Identification of patients who are at risk of developing foot problems Establish a risk score for patient as per NICE guidelines (Low, Moderate, High) Providing appropriate treatment/ assessment Education to patients and other professionals Work as part of larger multidisciplinary team
  4. 4. Vascular assessment  Palpate pulses or use Doppler Dorsalis Pedis Posterior Tibialis
  5. 5. ABPI     Can be useful in determining level of ischaemia Carried out when ischaemia is suspected Values of: <0.8: the foot is at risk of ulceration <0.5: the foot is critically ischaemic Caution: May give false readings in diabetic patients due to calcification of arteries consider pallor on elevation and dependant rubor also.
  6. 6. Neurological Assessment   Monofilament 8/10 or below neuropathy
  7. 7. Neurothesiometer Above 25 volts indicates presence of peripheral neuropathy
  8. 8. Typical features of Ulceration Neuropathic Ischaemic Pulses Bounding Diminished/absent Pain None/minimal High degree of pain Location of Ulceration Pressure areas Borders of feet Callus Often large amounts Minimal
  9. 9. Assessment of Diabetic Foot        Presence of Infection (bacteria and fungi) Ulceration/ foreign bodies Pre-ulcerative areas Deformity Oedema Skin quality Footwear
  10. 10. Debridement     Sharp debridement Allows true extent of ulcer to be revealed Allows healing with removal of slough and dead tissue Maggots
  11. 11. Case Study  Patient presented after walking on a gripper rod.
  12. 12. This was also discovered …
  13. 13. Wound Bed Granulating Sloughly
  14. 14. Dressings       Wound bed Consider patient Exudate management Moist healing environment Negative Pressure dressings Not the be all and end all !!
  15. 15. Biomechanics of foot    Altered foot function can be a cause of ulceration eg hallux limitus. Forefoot equinus Glycosylation of tissues and amount of deformity in foot can indicate severity of neuropathy
  16. 16. Offloading     Felt Bespoke insoles and footwear- rocker soles PRAFO Aircast
  17. 17. Conclusion    Podiatrists work as part of a multidisciplinary team when managing the diabetic foot The diabetic foot MUST be managed as part of a wide team involving a number of specialities. We all aim to facilitate healing and ensure the best care for the patient Thanks for listening 

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