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1362577835 preventive foot clinics dr gopalka

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preventive foot clinics dr gopalka

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1362577835 preventive foot clinics dr gopalka

  1. 1. Preventive Foot Clinics Sanjeev Kelkar
  2. 2. Why Preventive Foot Clinics? • Need • Concept • Actualization • Experience • Learning
  3. 3. Preventive Foot Clinics • Ulcer – gangrene – amputation – going on for long across the world and our country • Energy and resources spent – huge • Treat as you can, send when it complicates • An Attitude for early detection when no co- morbidities are present difficult to inculcate both among the HCPs and patients • Treating an unborn future that does not get conceived
  4. 4. Diabetic Foot Statistics • Estimated life time risk of diabetic foot - 15% • • 5-10% of all diabetic patients have or have had foot ulceration of various degrees and about 1% have undergone amputation • Diabetes accounts for up to 50% of non traumatic leg amputations* • Of all the diabetic amputees about 50% will lose their life or their other leg by 3 years
  5. 5. Major Problem in India • Neuropathic ulcer ( 85--95 %), Eminently preventable • Patients are younger, • Mean age of amputation earlier, • Far too many amputations for neuropathic ulcer. • Neuropathy that is significant enough to cause foot ulceration may affect 40% of diabetic population, especially elderly with type 2 diabetes. • Upto 35% of all diabetic patients have asymptomatic neuropathy • Diabetic Neuropathy affects 70% of the Diabetes patients –
  6. 6. The Compounded Problem • Component causes leading to foot ulcers • Peripheral neuropathy : 78% • Minor trauma : 77% • Deformity : 63% • Edema : 37% • Peripheral ischemia : 35% • Callus : 30% • Infection : 01%
  7. 7. The Compounded Problem • Contra-lateral amputation rate of 12 to 28% between 1 to 3 yrs • Mortality - 16 to 38% :1 year • - 35 to 65% :3 year • - 75 to 80% : 5 year
  8. 8. Preventive Foot Clinics Concept
  9. 9. Concept • Assembly line operation • Multiport data entry • End to end solution • Skill transfers
  10. 10. CLINICAL EXAMINATION
  11. 11. 1 2 3 1. Monofilament 2. Doppler 3. VPT Overview
  12. 12. DIABETES EDUCATORS AT FOOT CLINIC
  13. 13. DIABETES EDUCATORS AT FOOT CLINIC
  14. 14. PREVENTIVE FOOT CARE, AID, KMCH, CHENNAI, INDIA INDIVIDUAL COUNSELING
  15. 15. EDUCATOR’S COUNSELING THE PATIENTS FOOT CARE - THE 10 COMMANDMENTS
  16. 16. THE 10 COMMANDMENTS OF FOOT CARE EXPLAINED BY NURSE EDUCATOR
  17. 17. Preventive Foot Clinics - Assets • Enablers: Aware profession, available infrastructure within the country • Need: People from the lower economic strata have much higher levels of complications across the board – BUDS, CODI, NUDS,
  18. 18. Preventive Foot Clinics • Data entered online by three different persons – baseline at the reception, clinical by the doctor, SW MF, VPT, HCP in VPT negative patients by trained techs, • Doppler for PVD
  19. 19. Preventive Foot Clinics • Footwear inspection by a trained podiatrist, advice given, • Second phase of preventive foot clinic – • Aims at establishing capacity to manufacture in house foot wear, outsource it • The clinic charges for an extended period, not on a visit to visit basis, • People pay –tariff low
  20. 20. Preventive Foot Clinics These trained but non medical persons, they handle different jobs eg baseline clinical data work at reception, help manage data entry etc.
  21. 21. • Understand the problems
  22. 22. Preventive Foot Clinics • We can’t treat all, all along with the complications and all the works associated with it – let us face it • But we can teach and prevent • The real solution is prevention prevention and prevention
  23. 23. PREVENTIVE FOOT CARE CLINIC Dr. AMBEDKAR INSTITUTE OF DIABETES KILPAUK MEDICAL COLLEGE HOSPITAL Summary Statistics TOTAL NUMBER OF PATIENTS SCREENED : 6800 AS ON 14.7.2005
  24. 24. Number of patients examined : 6800 Number of patients with Foot problem : 5700 P. Neuropathy : 83.8%, PVD : 3.5 %, Foot ulcers : 4.5% Preventive foot care education : All 6800 Number of patients undergoing Minor / Major Amputations : 36
  25. 25. 43 57 0 10 20 30 40 50 60 MALE FEMALE MALE FEMALE TOTAL SCREENED - n = 6800 % FOOT EXAMINATION IN DIABETES
  26. 26. 83.8 36.4 47.4 0 10 20 30 40 50 60 70 80 90 TOTAL MALE FEMALE % OF MALES & FEMALES WITH FOOT PROBLEMS n = 6800 1) 16.2 % Did not have foot Problems 2) Problems were more in Females
  27. 27. FOOT PROBLEMS AT SCREENING - AID KMCH - CHENNAI 0 Ulcer Amputation Gangrene Corn ClawtoesFissures Calluses Fung. Inf IngrownToe Nails (n = 6800) %ofFootProblems 57.8 45.8 49.8 13.8 3.3 2.9 4.5 0.5 0.8 0 10 20 30 40 50 60
  28. 28. MONOFILAMENT EXAMINATION - n = 6800 60.5% 39.5% 0 10 20 30 40 50 60 70 P. Neuropathy in Diabetics - 1 NORMAL ABNORMAL %ofproblems Monafilament test is less reliable than VPT
  29. 29. 16.2 83.8 24.5 31.8 27.5 0 20 40 60 80 100 Normal Total VPT +ve Mild Moderate Severe Normal Total VPT +ve Mild Moderate Severe (n = 6800) P. Neuropathy in Diabetics - 2 Loss of VPT is more reliable test than MF
  30. 30. 1.5 8.2 34.7 54.3 1.3 0 10 20 30 40 50 60 Non DM <5 6 to 15 16 to 25 >25 DURATION OF DM – WITH FOOT PROBLEMS (n = 6800) Footproblems% Duration in Years > 256 to 15< 5 More than 50% have foot problems at < 5 years 16-25
  31. 31. FOOT WEAR IN DIABETICS - n = 6800 41 20.8 16.7 15.9 3.8 1.8 0 5 10 15 20 25 30 35 40 45 Hawai Plastic Others Bare Footed LeatherHawai MCR Plastic Others Foot Problems are more with Hawai & Plastics even with MCR – Great Toes / Little Toes were outside the Foot Wear. FootWear%
  32. 32. 34.7% 83.8% 3.5% n = 6800 NEUROPATHY Vs VASCULAR PROBLEMS IN DIABETICS NEUROPATHY VPT MF DOPPLER AB INDEX VASCULAR PVD is very minimal in this study
  33. 33. Action • Evaluate the findings • Pass the patient through an education session, put relevant educational material in vernacular in the hand • Monitoring advised, • Revisit fixed, drugs prescribed
  34. 34. What Paul Brand Said - We did • The single most important intervention to reduce amputation is to remove the footwear and see the feet of a diabetic • Paul Brand as told to the Americans
  35. 35. Educate, educate and educate Effect Of Patient Education On Amputation Rates Knee & Above 12% 15% 5% 46% 35% 60% Toe & Metatarsal Below Knee No Education Education University Hospital of Geneva 1979-1989. All comparisons p<0.001. Assal JP et al. Diabete Metab 1993.

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