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.

Diabetic Foot Lecture 2010

5,072 views

Published on

Lecture on Diabetic Foot Complications

Published in: Health & Medicine

Diabetic Foot Lecture 2010

  1. 1. Diabetic Foot Complications – Current treatments and advanced therapies in treating the diabetic foot Don Pelto, DPM Central Massachusetts Podiatry, PC Worcester, MA
  2. 2. Objectives • Participants will understand incidence and economic impact of diabetic foot infections • Participants will define the risk factors leading to diabetic foot infections • Participants will learn to diagnose an “at risk” diabetic foot • Participants will understand current treatments and advanced therapies in the standard of care/treatment for diabetic foot ulcers
  3. 3. Case Study M.S. • CC: Chronic ulceration right foot • PMH: DM-2, HTN, Restless Leg Syndrome • PSH: Unremarkable • NKDA • Meds: Glucophage, Humalog, Miripex, Lisinopril
  4. 4. Diabetic Foot Ulcers • One of the most common complications of diabetes • Annual incidence 1% to 4%1-2 • Lifetime risk 15% to 25%3-4 • ~15% of diabetic foot ulcers result in lower extremity amputation3,5 • ~85% of lower limb amputations in patients with diabetes are preceded by ulceration6-7 • Peripheral neuropathy is a major contributing factor in diabetic foot ulcers1-7 1. Reiber and Ledoux. In The Evidence Base for Diabetes Care. 4. Boulton et al. Lancet. 2005;366:1719. Williams et al, eds. Hoboken, NJ: John Wiley & Sons; 5. Ramsey et al. Diabetes Care 1999;22:382. 2002:641–665. 6. Pecoraro et al. Diabetes Care. 1990;13:513. 2. Boulton et al. NEJM. 2004;351:48. 7. Apelqvist and Larsson. Diabetes Metab Res Rev. 3. Sanders. J Am Podiatry Med Assoc. 1994;84:322. 2000:16:S75.
  5. 5. Costs to Treat a Diabetic Foot Ulcer Over a 2-Year Period Following Detection Ramsey et al. Diabetes Care. 1999;22:382. Cost analyses based on percent change in the medical component of the US consumer price index.
  6. 6. 5-Year Mortality Rates Armstrong DG, Wrobel J, Robbins JM. Guest Editorial: are diabetes-related wounds and amputations worse than cancer? Int Wound J. 2007;4(4):286–287
  7. 7. The Diabetic Foot – Risk Factors The Comprehensive Diabetic Foot Exam • Dermatological Considerations • Nerve Considerations • Osseous Considerations • Vascular Considerations • Shoegear Considerations Pinzur et al. Foot & Ankle International. 2005;26:1:113-119. Guidelines for diabetic footcare. Valk GD, Kriegsman DMW, Assendelft WJJ. Patient education for preventing diabetic foot ulceration. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD001488. DOI: 10.1002/14651858.CD001488.pub2.
  8. 8. Current and Advanced Treatments for Wounds
  9. 9. Dermatological Considerations • Dry Skin • Fungal Infection • Callus • Interdigital lesions • Ingrown Nail • Ulceration
  10. 10. Dermatological Considerations • Dry Skin • Fungal Infection • Callus • Interdigital lesions • Ingrown Nail • Ulceration
  11. 11. Dermatological Considerations • Dry Skin • Fungal Infection • Callus • Interdigital lesions • Ingrown Nail • Ulceration
  12. 12. Dermatological Considerations • Dry Skin • Fungal Infection • Callus • Interdigital lesions • Ingrown Nail • Ulceration
  13. 13. Dermatological Considerations • Dry Skin • Fungal Infection • Callus • Interdigital lesions • Ingrown Nail • Ulceration
  14. 14. Dermatological Considerations • Dry Skin • Fungal Infection • Callus • Interdigital lesions • Ingrown Nail • Ulceration
  15. 15. Dermatological Considerations • Dry Skin • Fungal Infection • Callus • Interdigital lesions • Ingrown Nail • Ulceration
  16. 16. Dermatological Considerations • Dry Skin • Fungal Infection • Callus • Interdigital lesions • Ingrown Nail • Ulceration
  17. 17. Dermatological Considerations • Dry Skin • Fungal Infection • Callus • Interdigital lesions • Ingrown Nail • Ulceration Spencer SA. Pressure relieving interventions for preventing and treating diabetic foot ulcers. Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD002302. DOI: 10.1002/14651858.CD002302.
  18. 18. Dermatological Treatments • Callus – Diabetic shoes • Ulceration – VAC – Debridement – Dermal Skin Substitute – Platelet Rich Plasma Spencer SA. Pressure relieving interventions for preventing and treating diabetic foot ulcers. Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD002302. DOI: 10.1002/14651858.CD002302.
  19. 19. Dermatological Treatments • Callus – Diabetic shoes • Ulceration – VAC – Debridement – Dermal Skin Substitute – Platelet Rich Plasma Ubbink DT, Westerbos SJ, Evans D, Land L, Vermeulen H. Topical negative pressure for treating chronic wounds. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD001898. DOI: 10.1002/14651858.CD001898.pub2.
  20. 20. Dermatological Treatments • Callus – Diabetic shoes • Ulceration – VAC – Debridement – Dermal Skin Substitute – Platelet Rich Plasma Edwards J, Stapley S. Debridement of diabetic foot ulcers. Cochrane Database of Systematic Reviews 2010, Issue 1.
  21. 21. Dermatological Treatments • Callus – Diabetic shoes • Ulceration – VAC – Debridement – Dermal Skin Substitute – Platelet Rich Plasma
  22. 22. Dermatological Treatments • Callus – Diabetic shoes • Ulceration – VAC – Debridement – Dermal Skin Substitute – Platelet Rich Plasma
  23. 23. Dermatological Treatments • Callus – Diabetic shoes • Ulceration – VAC – Debridement – Dermal Skin Substitute – Platelet Rich Plasma
  24. 24. Nerve Considerations • Neuropathy • Semmes Weinstein 5.07 monofilament (10g) • EMG and NCV
  25. 25. Nerve Treatments • Neuropathy – Medication Oral – Topical Medication – ENFB (Epidermal Nerve Fiber Biopsy)
  26. 26. Musculoskeletal Considerations • Foot Deformities • Plantar Pressure • Charcot Joint
  27. 27. Musculoskeletal Considerations • Foot Deformities • Plantar Pressure • Charcot Joint
  28. 28. Musculoskeletal Considerations • Foot Deformities • Gait Evaluation • Plantar Pressure • Charcot Joint
  29. 29. Musculoskeletal Treatments • Foot Deformities – Preventative foot surgery
  30. 30. Vascular Considerations • Pulses • Capillary filling time • Color changes • Edema • Temperature
  31. 31. Vascular Considerations • Pulses – Revascularization – Silverhawk – Vascular flaps
  32. 32. Shoegear Considerations • Type of shoe • Fit • Lining Wear • Insoles, Orthoses • Socks
  33. 33. Shoegear Modifications • Diabetic extra-depth shoes • Diabetic socks • Multi-density inserts
  34. 34. Thank You Don Pelto, DPM Central Massachusetts Podiatry, PC Worcester, MA 508.757.4003 don@worcesterfootcare.com

×