Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

1362562807 surgical anatomy of diabetic foot

979 views

Published on

surgical anatomy of diabetic foot

Published in: Health & Medicine
  • Be the first to comment

1362562807 surgical anatomy of diabetic foot

  1. 1. SURGICALSURGICAL ANATOMY OFANATOMY OF DIABETIC FOOTDIABETIC FOOT DR.ARUN BALDR.ARUN BAL MUMBAIMUMBAI
  2. 2. Leonardo da Vinci described the foot as “A masterpiece of engineering and a work of art” Dr.bal
  3. 3. HUMAN FOOT INHUMAN FOOT IN EVOLUTIONEVOLUTION  HUMAN FOOT HAS CULTURALHUMAN FOOT HAS CULTURAL VARIATIONSVARIATIONS  INDIAN FEET HAVE SHALLOWINDIAN FEET HAVE SHALLOW MEDIAL ARCHMEDIAL ARCH  SHALLOW MEDIAL ARCHSHALLOW MEDIAL ARCH INCREASES MEDIAL MOBILITYINCREASES MEDIAL MOBILITY AT MIDTARSAL JOINTSAT MIDTARSAL JOINTS
  4. 4. HUMAN FOOT IN EVOLUTION QUADRUPEDAL REQUIRES FOR GRIPPING ABILITY ORTHOGRADE/BIPEDAL REQUIRES FOR ABILITY TO SUPPORT Dr.bal
  5. 5. SURGICAL ANATOMY OFSURGICAL ANATOMY OF THE DIABETIC FOOTTHE DIABETIC FOOT FOOTFOOT THE FOOT CONSISTSTHE FOOT CONSISTS OF:OF: 29 JOINTS (8 MAJOR29 JOINTS (8 MAJOR & 21 MINOR)& 21 MINOR) 26 BONES26 BONES 42 MUSCLES42 MUSCLES
  6. 6. PLANTARPLANTAR ARCHESARCHES
  7. 7. ARCHES OF FOOTARCHES OF FOOT LONGITUDINALLONGITUDINAL TRANSVERSETRANSVERSE
  8. 8. LONGITUDINAL ARCHESLONGITUDINAL ARCHES MEDIAL:MEDIAL: HIGHERHIGHER MORE MOBILEMORE MOBILE RESILIENTRESILIENT LATERAL:LATERAL:LOWLOW LIMITED MOBILITYLIMITED MOBILITY BUILT TO BEAR WT.BUILT TO BEAR WT.
  9. 9. MEDIAL LONGITUDINALMEDIAL LONGITUDINAL ARCHARCH  CAL-TAL-NAV-CUN-THREE MED MTCAL-TAL-NAV-CUN-THREE MED MT  ENDEND:HEADS OF MEDIAL THREE MT:HEADS OF MEDIAL THREE MT  SUMMITSUMMIT:SUP.ART.SURFACE - TALUS:SUP.ART.SURFACE - TALUS  ANT.PILLAR:ANT.PILLAR:TALUS-NAV-THREE MTTALUS-NAV-THREE MT  POST PILLAR:POST PILLAR:MEDIAL HALF OF CALMEDIAL HALF OF CAL
  10. 10. LATERAL LONGITUDINALLATERAL LONGITUDINAL ARCHARCH  CALCANEUM-CUBOID-TWO LAT MTCALCANEUM-CUBOID-TWO LAT MT  ENDEND:HEADS OF 4TH&5TH MT:HEADS OF 4TH&5TH MT  SUMMIT:SUMMIT:SUP.SURFACE OF CALSUP.SURFACE OF CAL  ANT.PILLAR:ANT.PILLAR:CUBOID-TWO LAT MTCUBOID-TWO LAT MT  POST.PILLAR:POST.PILLAR:LAT.HALF OF CALLAT.HALF OF CAL
  11. 11. TRANSVERSE ARCHES
  12. 12.  MEDIAL:MEDIAL:  PLANTAR APONEUROSISPLANTAR APONEUROSIS  FLEX.DIG.BREVISFLEX.DIG.BREVIS  ABDUCTOR HALLUSISABDUCTOR HALLUSIS  TIBIALIS ANTERIORTIBIALIS ANTERIOR  TIBIALIS POSTERIORTIBIALIS POSTERIOR  FLEX.HAL.LONGUSFLEX.HAL.LONGUS MAINTENANCE OF FOOTMAINTENANCE OF FOOT ARCHESARCHES
  13. 13. MAINTENANCE OF FOOTMAINTENANCE OF FOOT ARCHESARCHES LATERALLATERAL::  LATERAL PLANTARLATERAL PLANTAR APONEUROSOS .APONEUROSOS .  ABD.DIG.MINIMIABD.DIG.MINIMI  PERONEUS LONGUSPERONEUS LONGUS  PERONEUS BREVISPERONEUS BREVIS
  14. 14. FUNCTIONS OF FOOTFUNCTIONS OF FOOT ARCHESARCHES  DISTRIBUTION OF BODY WEIGHTDISTRIBUTION OF BODY WEIGHT  ELASTICITY HELPS IN WALKINGELASTICITY HELPS IN WALKING  SHOCK ABSORBERSHOCK ABSORBER  CONCAVITY PROTECTS SOFTCONCAVITY PROTECTS SOFT TISSUES AND BLOOD VESSELSTISSUES AND BLOOD VESSELS
  15. 15. LIGAMENTS OFLIGAMENTS OF FOOTFOOT
  16. 16. LIGAMENTS OF FOOTLIGAMENTS OF FOOT  DELTOID LIGAMENTDELTOID LIGAMENT  LATERAL LIGAMENTLATERAL LIGAMENT  SPRING LIGAMENTSPRING LIGAMENT  LONG PLANTAR LIGAMENTLONG PLANTAR LIGAMENT  SHORT PLANTAR LIGAMENTSHORT PLANTAR LIGAMENT
  17. 17. LATERAL LIGAMENT
  18. 18. DELTOID LIGAMENT
  19. 19. PLANTAR(FASCIALPLANTAR(FASCIAL ) SPACES) SPACES
  20. 20. MEDIAL PLANTAR SPACEMEDIAL PLANTAR SPACE  DORSAL:DORSAL:INF SURFACE OF 1STMTINF SURFACE OF 1STMT  MEDIAL:MEDIAL:PLANTAR FASCIA EXTENSIONPLANTAR FASCIA EXTENSION  LATERALLATERAL::INTERMUSCULAR SEPTUMINTERMUSCULAR SEPTUM CONTENTS:CONTENTS: ADD.HALLUSISADD.HALLUSIS  FLEXOR H.LONGUSFLEXOR H.LONGUS  TIB.POSTERIORTIB.POSTERIOR  FLEXOR H.BREVISFLEXOR H.BREVIS  PERONEAL LONGUSPERONEAL LONGUS
  21. 21. CENTRAL PLANTARCENTRAL PLANTAR SPACESPACE  INFERIOR:INFERIOR:PLANTAR FASCIAPLANTAR FASCIA  LATERAL:LATERAL:INTERMUSCULAR SEPTUMINTERMUSCULAR SEPTUM  DORSAL:DORSAL:TARSOMETATARSAL JTSTARSOMETATARSAL JTS CONTENTS:CONTENTS: FLEXOR DIG LONGUSFLEXOR DIG LONGUS  FLEXOR DIG BREVISFLEXOR DIG BREVIS  LUMBRICALSLUMBRICALS  PERONEAL&POST TIB.PERONEAL&POST TIB.  ADD.HAL.MUSCLEADD.HAL.MUSCLE
  22. 22. LATERAL PLANTARLATERAL PLANTAR SPACESPACE  DORSAL:DORSAL: 5TH METATARSAL5TH METATARSAL  MEDIAL:MEDIAL:INTERMUSCUALRINTERMUSCUALR SEPTUMSEPTUM  LATERAL:LATERAL:PLANTAR FASCIAPLANTAR FASCIA CONTANTSCONTANTS::ABDUCTOR DIG.ABDUCTOR DIG.  FLEXOR DIG QUINTIFLEXOR DIG QUINTI  SMALL MUSCLES OFSMALL MUSCLES OF  5TH TOE5TH TOE
  23. 23. CONCEPT OF PLANTAR SPACES
  24. 24. PLANTAR SPACES
  25. 25. SURGICAL TREATMENTSURGICAL TREATMENT OF DIABETIC FOOTOF DIABETIC FOOT MID FOOTMID FOOT ABCESS WITHABCESS WITH TOE GANGRENETOE GANGRENE Dr.bal
  26. 26. SURGICAL TREATMENTSURGICAL TREATMENT OF DIABETIC FOOTOF DIABETIC FOOT DRAINAGEDRAINAGE OF MID FOOTOF MID FOOT ABCESS-ABCESS- POSTPOST OPERATIVEOPERATIVE Dr.bal
  27. 27. PLANTARPLANTAR FASCIAFASCIA
  28. 28. SUP.TRAN.MT. LIGAMENTS TRANS. FASCIC.
  29. 29. ROLE OF PLANTAR FASCIA IN LJM
  30. 30. ROLE OF PLANTARROLE OF PLANTAR FASCIA IN FOOTFASCIA IN FOOT ULCERATIONULCERATION RUPTURE OF PLANTAR FASCIARUPTURE OF PLANTAR FASCIA  ATTACHMENT OF PLANTAR FASCIAATTACHMENT OF PLANTAR FASCIA TO SKIN UNDER 1ST MTTO SKIN UNDER 1ST MT  GLYCATION OF FASCIA CHANGES THEGLYCATION OF FASCIA CHANGES THE LOADING PATTERN OF THE FOOTLOADING PATTERN OF THE FOOT
  31. 31. ARTERIES OF THEARTERIES OF THE FOOTFOOT
  32. 32. ARTERIES OF THEARTERIES OF THE FOOTFOOT  POST.TIBIAL IS DOMINANT VESSELPOST.TIBIAL IS DOMINANT VESSEL  POST.TIBIAL IS CLOSELY RELATED TOPOST.TIBIAL IS CLOSELY RELATED TO THE TENDON OF F.H.L.THE TENDON OF F.H.L.  LAT.PLANTAR ARTERY IS MAJORLAT.PLANTAR ARTERY IS MAJOR BRANCH OF POST.TIBIALBRANCH OF POST.TIBIAL  ANT.TIBIAL CONTRIBUTES TO THEANT.TIBIAL CONTRIBUTES TO THE BLOOD SUPPLY TO 1,2 DIGITSBLOOD SUPPLY TO 1,2 DIGITS
  33. 33. POPLITEAL ARTERY TIBIOPERONEAL TRUNK POST TIBIAL PERONEAL ANT.TIBIAL
  34. 34. SURGICAL ANATOMY OFSURGICAL ANATOMY OF THE FOOTTHE FOOT ARTERIES OFARTERIES OF THE FOOTTHE FOOT
  35. 35. CAUSE OF NEUROPATHIC ODEMA
  36. 36. CROWDING OF TOES CAUSING ARTERIAL THROMBOSIS
  37. 37. ANATOMY OF THE HEEL
  38. 38. NERVES OF THE FOOTNERVES OF THE FOOT
  39. 39. PERONEAL N. TIBIAL NERVE
  40. 40. TIBIAL N LATERAL PLANTAR NERVE MEDIAL PLANTAR NERVE
  41. 41. FOOTFOOT MOVEMENTSMOVEMENTS
  42. 42. AXIS OF ANKLE MOVEMENT
  43. 43. FOOTFOOT BIOMECHANICSBIOMECHANICS
  44. 44. NORMAL WALKING CYCLENORMAL WALKING CYCLE Initial contact Forefoot contact Heel lift Toe-off Dr.bal
  45. 45. HEEL STRIKEHEEL STRIKE Initial contact Start midstace Start foot flat Dr.bal
  46. 46. MIDSTANCE PHASEMIDSTANCE PHASE Start mischance Start foot flat Heel lift Dr.bal
  47. 47. PROPULSION PHASEPROPULSION PHASE Heel lift Toe-off Dr.bal
  48. 48. NeutralNeutral PositionPosition DYNAMIC 3 DIMENSIONAL ORTHOSIS Alpha: Rear-foot Position Dr.bal
  49. 49. Rear-footRear-foot pronationpronation (Valgus)(Valgus) DYNAMIC 3 DIMENSIONAL ORTHOSIS Alpha: Rear-foot Position Dr.bal
  50. 50. Rear-foot supination (varus) DYNAMIC 3 DIMENSIONAL ORTHOSIS Alpha: Rear-foot Position Dr.bal
  51. 51. IMPULSE LOADINGIMPULSE LOADING IS MOREIS MORE RELEVENT THANRELEVENT THAN ONLY HIGHONLY HIGH PRESSUREPRESSURE
  52. 52. IMPULSE LOADINGIMPULSE LOADING IS PRODUCT OFIS PRODUCT OF PRESSURE ANDPRESSURE AND GROUNDGROUND CONTACT TIMECONTACT TIME
  53. 53. Excessive pronation (cont.) DISORDERS OF THE FOOT Dr.bal
  54. 54. MAJORITY OF DIABETIC FOOT ULCERS ARE IN THE REGION OF 1ST MTP JOINT
  55. 55. FOOTFOOT PATHOBIOMECHANIPATHOBIOMECHANI CSCS
  56. 56. HALLAUX RIGIDUS
  57. 57. HALLAUX RIGIDUS
  58. 58. MECHANISM OFMECHANISM OF DIABETIC FOOT ULCERDIABETIC FOOT ULCER ROLE OFROLE OF HALLAUXHALLAUX RIGIDUS ANDRIGIDUS AND SUBCUT.PADSUBCUT.PAD OF FATOF FAT
  59. 59. PATHO BIOMECHANICSPATHO BIOMECHANICS OF DIABETIC FOOTOF DIABETIC FOOT ULCERULCER  MECHANISMMECHANISM OF DIABETICOF DIABETIC FOOT ULCERFOOT ULCER Dr.bal
  60. 60. HAMMER TOE MALLET TOE CLAW TOE
  61. 61. HAWAI(WEB & TOEHAWAI(WEB & TOE STRAP) SLIPPERSSTRAP) SLIPPERS ACCENTUATE TOEACCENTUATE TOE DEFORMITIESDEFORMITIES
  62. 62. HAWAI SLIPPERS /STANDING
  63. 63. HAWAI SLIPPERS /WALKING TOE PRESSUR E
  64. 64. PATHO- BIOMECHANICSPATHO- BIOMECHANICS OF DIABETIC FOOTOF DIABETIC FOOT ULCCEERULCCEER BIOMECHANICBIOMECHANIC S OF FORES OF FORE FOOTFOOT AMPUTATIONAMPUTATION Dr.bal
  65. 65. PATH -BIOMECHANICSPATH -BIOMECHANICS OF DIABETIC FOOTOF DIABETIC FOOT ULCERULCER BIOMECHANICBIOMECHANIC S OFS OF FOREFOOTFOREFOOT AMPUTATIONAMPUTATION Dr.bal
  66. 66. NORMAL AXIS OF MTP JTS
  67. 67. CAUSE OF 2ND MT ULCER
  68. 68. SEPARATION 1ST AND 2ND CUNEIFORM IN CHARCOT`S FOOT
  69. 69. SEPARATION OF 1ST AND 2ND CUNEIFORM IN CHARCOT`S FOOT
  70. 70. ANGLE OF ADDUCTUS PRIMUS
  71. 71. LISFRANC`S JOINT
  72. 72. CHARCOT`S FOOTCHARCOT`S FOOT EARLIESTEARLIEST RADIOLOGICALRADIOLOGICAL SIGNSIGN Dr.bal LISFRANC`S JOINT
  73. 73. LOAD TRAINGLE
  74. 74. AXIS OF WEIGHT TRANSMISSION
  75. 75. BILATERAL CHARCOT
  76. 76. SURGICAL ANATOMY OFSURGICAL ANATOMY OF THE DIABETIC FOOTTHE DIABETIC FOOT  NEURO ARTHROPATHYNEURO ARTHROPATHY OCCURS:OCCURS:  60% IN TARSAL &TARSO60% IN TARSAL &TARSO MT JOINTSMT JOINTS  30% META TARSO30% META TARSO PHALANGEAL JOINTSPHALANGEAL JOINTS  10% ANKLE JOINTS10% ANKLE JOINTS
  77. 77. SURGICAL ANATOMY OFSURGICAL ANATOMY OF THE FOOTTHE FOOT FOOT SIZEFOOT SIZE DOES NOTDOES NOT CHANGE WITHCHANGE WITH AGE BUTAGE BUT SHAPESHAPE CHANGESCHANGES
  78. 78. MECHANISM OF PES CAVUS
  79. 79. ANATOMICAL BASIS OFANATOMICAL BASIS OF SPREADING FOOTSPREADING FOOT INFECTIONINFECTION
  80. 80. FOOT IS MOSTFOOT IS MOST ENERGY EFFICIENTENERGY EFFICIENT MACINE.THISMACINE.THIS ENERGYENERGY EFFECIENCY ISEFFECIENCY IS LOST IN DIABETESLOST IN DIABETES DUE TODUE TO NEUROPATHYNEUROPATHY Dr.bal
  81. 81. HUMAN FOOT CAN NOTHUMAN FOOT CAN NOT BE STUDIED INBE STUDIED IN EXPERIMENTAL ANIMALEXPERIMENTAL ANIMAL MODELSMODELS
  82. 82. FUNDAMENTAL PRINCIPLEFUNDAMENTAL PRINCIPLE OF DIABETIC FOOTWEAROF DIABETIC FOOTWEAR FOOTWEARFOOTWEAR SHOULD DOSHOULD DO WHAT FOOT CANWHAT FOOT CAN NOT DONOT DO
  83. 83. TAKE HOME MESSAGETAKE HOME MESSAGE KNOWLEDGE OF FOOTKNOWLEDGE OF FOOT ANATOMY &ANATOMY & BIOMECHANICS ISBIOMECHANICS IS ESSENTIAL FORESSENTIAL FOR PREVENTION OF HIGHERPREVENTION OF HIGHER LEVEL AMPUTATION INLEVEL AMPUTATION IN DIABETESDIABETES
  84. 84. An ancient Sanskrit saying. “The one who walks, his good fortune also marches ahead.” PRESERVE & PROTECT THEM
  85. 85. THANK YOUTHANK YOU

×