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1362465156 diabetic foot ulcer etiopathogenesis & management

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diabetic foot ulcer etiopathogenesis & management

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1362465156 diabetic foot ulcer etiopathogenesis & management

  1. 1. DIBETIC FOOT ULCER ETIO-PATHOGENESIS & MANAGEMENT DR.ARUN BAL S.L.RAHEJA HOSPITAL
  2. 2. METHOD OF OFF-LOADING • BEDREST • CRUCTHES • WHEELCHAIR • SPECIAL FOOTWEAR • CONTACT CASTING
  3. 3. MECHANISM OF INJURY • DIRECT PENETRATION OF SKIN • SMALL AMOUNT OF FORCE SUSTAINED OVER A PERIOD OF TIME • MODERATE AMOUNT OF REPATATIVE FORCE
  4. 4. INDICATION OF WORSENING INFECTION • INCREASED DRAINAGE • INCREASED ERYTHEMA • SUDDEN INCREASE IN PAIN • INCREASED WARMTH • FOUL ODOUR • LYMPHANGITIS
  5. 5. INDICATION OF WORSENING INFECTION(CONT) • INCREASED BLOOD GLUCOSE LEVEL • INCREASED WBC LEVEL • INCREASED E.S.R • REDUCED QUADRICEPS ACTION • PERSISTANT ANOREXIA • HIGH SERUM CREATININE
  6. 6. • OFF LOADING OF AFFECTED FOOT
  7. 7. WHAT CAUSES HIGH PLANTAR PRESSURE? • DISPLACEMENT OF METATARSAL CUSHION DISTALLY • NON ENZYMATIC GLYCOLISATION • LIMITATION OF MOVEMENT OF 1ST MTP JOINT • REDUCED ELASTICITY
  8. 8. WHAT CAUSES HIGH PLANTAR PRESSURE? • DECREASED SUBTALAR JOINT MOVEMENT • EXCESSIVE PLANTAR KERATOSIS • THICKENING OF SESMOID • ADHESIONS & SCAR TISSUE
  9. 9. HOW DOES FOOT INJURY OCCUR? • PEAK PLANTAR PRESSURE:1340kPa • SYSTOLIC BP 120 mm OF H:15 kPa • CAPILLARY PRESSURE :6 kPa • DELAYED/ABSENT RECOVERY FROM ISCHAEMIA • DELAYED/ABSENT RECOVERY OF NORMAL TISSUE OXYGEN CONC.
  10. 10. HOW DOES FOOT INJRY OCCUR? • REPATATIVE MODERATE FORCE • INFLAMMATION • ERYTHEMA AND WARMTH • COLLECTION OF EXUDATE • BLISTER FORMATION • BREAKDOWN OF SKIN --- ULCER
  11. 11. NEED FOR PROMPT TREATMENT OF FOOT ULCER • 85% OF DIABETIC FOOT AMPUTATIONS ARE DUE TO INADEQUATELY TREATED FOOT ULCER • 30-50% AMPUTEES REQUIRE CONTRALATERAL AMPUTATION IN 3 YEARS
  12. 12. NEED FOR PROMPT TREATMENT IF FOOT ULCER • 10% MORTALITY IN THREE YEARS IN AMPUTEES • ECONOMIC LOSS TO FAMILY AND SOCIETY • 22% REQUIRE IPSILATERAL HIGHER AMPUTATION
  13. 13. FOOT ULCER ASSESSMENT • PERIWOUND ERYTHEMA • PERIWOUND ODEMA • WOUND PURULENCE • WOUND FIBRIN • LIMB PITTING ODEMA • LIMB BRAWNY ODEMA
  14. 14. FOOT ULCER ASSESSMENT • WOUND GRANULATION • VASCULAR STATUS • WOUND MEASUREMENT • OSTEOMYLITIS & TENOSYNOVITIS
  15. 15. MECHANISM OF INJURY IN DIABETIC FOOT • NORMAL STRESS • SHEAR STRESS • FATIGUE • STRESS CONCENTRATION • ELATICITY
  16. 16. PRIMARY TREATMENT OF DIABETIC FOOT ULCER • EVALUATION • METABOLIC CONTROL • DEBRIDEMENT • BACTERIAL CULTURE
  17. 17. PRIMARY TREATMENT OF DIABETIC FOOT ULCER • PARENTERAL ANTIBIOTICS • OFF LOADING OF AFFECTED FOOT • REVASCULARIZATION • CORRECT FOOTWEAR
  18. 18. OBJECTIVES OF DIABETIC FOOT WEAR • REDUCTION OF EXCESSIVE PLANTAR PRESSURE • REDUCTION OF SHOCK • REDUCTION OF SHEAR • ACCOMODATION OF DEFORMITY • STABALIZATION OF DEFORMITY • LIMITATION OF JOINT MOVEMENT
  19. 19. OBJECTIVES OF DIABETIC FOOTWEAR • WIDE TOEBOX • EXTRA DEPTH • SOFT UPPERS • MCR/PLASTAZOAT INSOLE • INSOLE WING PAD • ORTHOWDGE CORRECTION • WELL FITTING SOCKS
  20. 20. SURGERY FOR DIABETIC FOOT ULCER • PROPHYLACTIC • THERAPEUTIC
  21. 21. PRPHYLACTIC SURGERY FOR DIABETIC FOOT ULCER • METATARSAL OSTEOTOMY • METATARSAL HEAD RESECTION • SESMOIDECTOMY • DIGITAL ARTHROPLASTY • BUNIONECTOMY • LOCAL FLAPS

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