This document outlines a brief assessment of the foot for patients at risk of foot complications, including seniors, those with low vision, hypertension, poor circulation, edema, arthritis, diabetes, obesity or other comorbidities. It describes assessing for issues like poor circulation, deformities, infections, ulcers and nerve damage. The assessment includes checks of sensation, pulses, foot structure, skin integrity and footwear. Risk is stratified based on factors present, and follow up recommended from annual to every 3-6 months or immediate referral based on risk level. Education on self care, monitoring and when to seek help is advised to help prevent foot complications.
This document discusses the examination of diabetic feet, which are at risk for ulcers and lower extremity amputation. There are three main causes of diabetic foot complications: neuropathy, foot deformity, and minor trauma. It is important for clinicians to check for loss of protective sensation, foot deformities, and history of foot problems. The foot examination should inspect for deformities, ulcers, skin and nail integrity, and evaluate sensation using tests like monofilament and vibration. Vascular assessment includes checking pulses, ankle-brachial index, and other blood flow measurements. A thorough diabetic foot exam can detect problems and help prevent further complications.
The document discusses diabetic foot complications including ulceration and infection. It provides details on:
1) Evaluating and diagnosing foot issues in diabetics through history, examination, and investigations including imaging and microbiology tests.
2) Classifying foot ulcers into grades based on severity to guide treatment, which may include debridement, antibiotics, and surgery such as amputation for severe cases.
3) Managing common issues like Charcot neuroarthropathy through a multidisciplinary approach including offloading and bracing to prevent deformity.
Diabetic foot ulcers pose a serious risk for patients with diabetes. The document discusses that diabetic patients have up to a 25% lifetime risk of developing a foot ulcer, with annual incidence rates of 3-10%. Key risk factors include neuropathy, peripheral vascular disease, foot deformities, and inappropriate footwear. Management requires a multidisciplinary approach including wound care, infection control, offloading pressure areas, and patient education on proper foot self-care. The goals are to heal ulcers, prevent amputation, and maintain foot health and function.
This document discusses the epidemiology, pathogenesis, pathology, classification, management, and treatment of diabetic foot. It notes that diabetic foot affects 15% of diabetics globally and can result in high rates of amputation. Management is multi-disciplinary and involves history, examination, investigations, prevention, wound care, offloading, revascularization procedures, and amputation if needed. Good diabetic control and foot care education are essential to preventing and treating diabetic foot complications.
Diabetic foot complications are a major cause of lower limb amputations. Factors like neuropathy, vasculopathy and immune dysfunction contribute to foot ulceration and infection in diabetes. Ulcers are classified based on etiology and severity. Management involves metabolic control, wound care, offloading, antibiotics, vascular assessment and revascularization if needed. Long term prevention relies on regular foot screening, education on foot care, appropriate footwear and multidisciplinary team approach.
The document provides a detailed history and overview of diabetes and diabetic foot complications. Some key points:
- Up to 70% of diabetics develop neuropathy which causes loss of sensation in the feet and increases risk of foot ulcers and amputation.
- Insulin was discovered in 1921-1922 by Banting, Best, Macleod and Collip through experiments involving pancreases of dogs.
- Foot ulcers and infections are common complications and are classified in systems like Wagner and UT classifications based on severity, presence of infection or ischemia.
- Neuropathy, peripheral vascular disease and foot deformities increase risk of foot complications. Managing blood sugar, offloading wounds, and preventative foot care can help reduce
This document discusses diabetic foot ulcers. It defines a diabetic foot ulcer and lists risk factors such as neuropathy and peripheral vascular disease. It describes the etiology involving neuropathy, angiopathy, and infection. Clinical presentation includes examination of the ulcer, skin, pulses, and neurological assessment. Classification systems like Wagner's are mentioned. Workup involves biochemical testing, imaging, and assessment of vascular and neurological function. Management discusses wound care, offloading pressure, infection treatment, and surgical interventions.
This document discusses the examination of diabetic feet, which are at risk for ulcers and lower extremity amputation. There are three main causes of diabetic foot complications: neuropathy, foot deformity, and minor trauma. It is important for clinicians to check for loss of protective sensation, foot deformities, and history of foot problems. The foot examination should inspect for deformities, ulcers, skin and nail integrity, and evaluate sensation using tests like monofilament and vibration. Vascular assessment includes checking pulses, ankle-brachial index, and other blood flow measurements. A thorough diabetic foot exam can detect problems and help prevent further complications.
The document discusses diabetic foot complications including ulceration and infection. It provides details on:
1) Evaluating and diagnosing foot issues in diabetics through history, examination, and investigations including imaging and microbiology tests.
2) Classifying foot ulcers into grades based on severity to guide treatment, which may include debridement, antibiotics, and surgery such as amputation for severe cases.
3) Managing common issues like Charcot neuroarthropathy through a multidisciplinary approach including offloading and bracing to prevent deformity.
Diabetic foot ulcers pose a serious risk for patients with diabetes. The document discusses that diabetic patients have up to a 25% lifetime risk of developing a foot ulcer, with annual incidence rates of 3-10%. Key risk factors include neuropathy, peripheral vascular disease, foot deformities, and inappropriate footwear. Management requires a multidisciplinary approach including wound care, infection control, offloading pressure areas, and patient education on proper foot self-care. The goals are to heal ulcers, prevent amputation, and maintain foot health and function.
This document discusses the epidemiology, pathogenesis, pathology, classification, management, and treatment of diabetic foot. It notes that diabetic foot affects 15% of diabetics globally and can result in high rates of amputation. Management is multi-disciplinary and involves history, examination, investigations, prevention, wound care, offloading, revascularization procedures, and amputation if needed. Good diabetic control and foot care education are essential to preventing and treating diabetic foot complications.
Diabetic foot complications are a major cause of lower limb amputations. Factors like neuropathy, vasculopathy and immune dysfunction contribute to foot ulceration and infection in diabetes. Ulcers are classified based on etiology and severity. Management involves metabolic control, wound care, offloading, antibiotics, vascular assessment and revascularization if needed. Long term prevention relies on regular foot screening, education on foot care, appropriate footwear and multidisciplinary team approach.
The document provides a detailed history and overview of diabetes and diabetic foot complications. Some key points:
- Up to 70% of diabetics develop neuropathy which causes loss of sensation in the feet and increases risk of foot ulcers and amputation.
- Insulin was discovered in 1921-1922 by Banting, Best, Macleod and Collip through experiments involving pancreases of dogs.
- Foot ulcers and infections are common complications and are classified in systems like Wagner and UT classifications based on severity, presence of infection or ischemia.
- Neuropathy, peripheral vascular disease and foot deformities increase risk of foot complications. Managing blood sugar, offloading wounds, and preventative foot care can help reduce
This document discusses diabetic foot ulcers. It defines a diabetic foot ulcer and lists risk factors such as neuropathy and peripheral vascular disease. It describes the etiology involving neuropathy, angiopathy, and infection. Clinical presentation includes examination of the ulcer, skin, pulses, and neurological assessment. Classification systems like Wagner's are mentioned. Workup involves biochemical testing, imaging, and assessment of vascular and neurological function. Management discusses wound care, offloading pressure, infection treatment, and surgical interventions.
Osteoarthritis is the most common form of joint disease worldwide, typically affecting older individuals over 70 years of age. It results from mechanical and biochemical insults that exceed the joint's ability to repair itself. The disease causes the breakdown of cartilage in joints like the hips, knees, spine, hands and feet. Key pathological features include the loss of articular cartilage and sclerosis of underlying bone. Risk factors include age, genetics, obesity, previous injury and occupational factors. Symptoms include pain, stiffness and reduced mobility. Management involves symptomatic therapies like exercise, weight loss and braces as well as surgical options like joint replacement for severe cases.
This document discusses risk factors, causes, signs, and management of diabetic foot ulcers. It notes that peripheral neuropathy and vascular disease increase risk by impairing sensation and blood flow. Ulcers form where calluses or bony deformities concentrate pressure. Evaluation includes wound culture and imaging to check for osteomyelitis. Treatment involves wound debridement, offloading pressure, and antibiotics for infection. Surgery may be needed for uncontrolled infection, amputation, or deformity correction. Regular foot screening and appropriate footwear can help prevent ulcers.
This document discusses the pathophysiology and management of diabetic foot. It covers the epidemiology, risk factors, classification, pathogenesis involving neuropathy, infection, ischemia, and biomechanics. It also describes the clinical evaluation including history focusing on previous foot problems and risk factors, and physical examination assessing neuropathy, infection, and ischemia. Thorough examination of the foot and wound is important to guide appropriate management.
This document provides information about amputation procedures. It describes the indications for amputation, including peripheral vascular disease, diabetic limb disease, trauma, infection, malignancy, and deformity. The goals of amputation are to return the patient to maximum function, ablate diseased tissue, reduce morbidity and mortality, and produce a physiological end organ. Different types of amputations are described for the toes, feet, legs, arms, and limbs. Principles for determining the amputation level and performing the procedure are outlined. Postoperative management focuses on wound healing, edema control, pain management, and rehabilitation to prevent contractures. Potential complications are also reviewed.
This document discusses the approach to diabetic foot problems. It defines diabetic foot as a disease involving neuropathy, angiopathy, and infection leading to tissue breakdown and possible amputation. Diabetic foot affects 15% of Jordan's diabetic population and can result in ulcers, osteomyelitis, and amputation. Proper assessment involves examination of the skin, nerves, blood vessels, and any wounds or infections. Treatment requires a multidisciplinary team approach involving different medical specialties.
Osteoarthritis is the most common form of arthritis that affects the joints, especially in those over 45 years old. It involves the breakdown of cartilage in the joints which leads to pain, stiffness, and reduced mobility. Risk factors include age, genetics, joint injuries, and obesity. Symptoms may include joint pain, stiffness, swelling, and grinding sensations. Diagnosis involves physical exams, x-rays showing cartilage loss and bone spurs, and ruling out other causes. Treatment focuses on reducing pain and inflammation with medications and physical therapy, as well as weight loss and joint protection. For severe cases, surgical options like joint replacement may be considered.
The document discusses amputation, including definitions, history, indications, types, postoperative care, complications, and special procedures. It notes that amputation involves surgical removal of part or all of a limb through bone or joints. The main indications are trauma, peripheral vascular disease, infection, tumors, and congenital anomalies. Postoperative goals are prompt healing, edema control, pain management, and early rehabilitation and prosthesis training. Complications can include wound issues, infection, phantom pain, and psychological impacts.
ueda2012 predictors of diabetic foot ulcer-d.walaaueda2015
This document summarizes a study examining predictors of outcome for diabetic foot ulcers at Assiut University Hospital in Egypt. The study prospectively followed 100 patients with diabetic foot ulcers for up to one year to determine factors associated with complete healing within that time period. So far, data has been collected on 50 patients. Preliminary results found that 68% of patients were female, with a mean age of 50.76 years. Factors examined included demographics, medical history, foot examination findings, ulcer characteristics, and lab results. The aim is to identify baseline characteristics that can predict poorer outcomes like non-healing of the ulcer.
This presentation discusses diabetic foot complications. It begins with an overview of topics to be covered, including the concept of diabetic foot, its complications like ulcer, neuropathy and arthropathy, infections and amputations, and management through medical and physiotherapy approaches. Diabetic foot refers to any pathology resulting from diabetes and is caused by a triad of ischemia, neuropathy and infection. Complications include ulcers, neuropathy, arthropathy and infections, which can sometimes lead to amputation. The presentation discusses assessment, medications, footwear, bracing, exercises and other physiotherapy techniques for managing diabetic foot complications.
Osgood-Schlatter disease is a common cause of knee pain in children aged 10-15 years, characterized by gradual onset of pain below the kneecap. It is caused by forceful contractions of the quadriceps muscle pulling on the tibial tuberosity via the patellar tendon, which can cause small fractures or inflammation in the growing bone. Diagnosis is typically made clinically based on the age of the patient, location of pain, and tenderness over the tibial tuberosity. Treatment involves reducing activity, pain management, and physiotherapy. The condition is usually self-limiting and resolves within a year as the bone matures.
The document discusses the diagnosis and management of knee osteoarthritis (OA), outlining the epidemiology, risk factors, clinical evaluation including history, physical exam and diagnostic tests, differential diagnosis, and treatment options focused on lifestyle modifications, medications including analgesics and intra-articular injections, and surgery for advanced cases.
Diabetic foot is caused by the interaction of neuropathy, abnormal foot biomechanics, and peripheral arterial disease impairing wound healing. This leads to foot ulcers and infections, which are graded from 0 to 5 based on severity. Management involves glycemic control, footwear modification, wound care, and antibiotics or surgery depending on grade. Preventing and treating diabetic foot complications reduces lower extremity amputations.
Dr. Vinay Jain presented on diabetic foot. Some key points:
1. Diabetes can cause nerve damage (neuropathy), poor circulation (peripheral arterial disease), and foot deformities which make the feet susceptible to ulcers and infection.
2. About 15% of diabetics develop foot lesions in their lifetime, with an amputation rate 15 times higher than non-diabetics.
3. Risk factors for foot complications include long diabetes duration, neuropathy, past ulcer/amputation, and poor blood sugar control.
4. Treatment depends on the severity of the ulcer and includes wound cleaning, offloading pressure (casts, special shoes), surgery if needed, and amputation in
This document outlines the assessment process for diabetes mellitus (DM) and diabetic foot ulcers. It involves collecting demographic data, medical history, and symptoms. A physical exam evaluates multiple body systems including the eyes, skin, limbs, and feet. Feet are examined for deformities, ulcers, skin/nail changes. Ulcers are characterized by location, size, depth, edges, floor, and surrounding skin. Sensation is tested. Joint and muscle function are assessed along with functional mobility.
DIABETIC FOOT ULCER- / SURGICAL WOUNDS
#surgicaleducator #diabeticfootulcer #surgicaltutor #babysurgeon #usmle
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today in this episode I have discussed Diabetic Foot Ulcer- DFU
• It is a complication of Type 2 Diabetes
• I have discussed about the overview, epidemiology, etiopathogenesis, clinical features, assessment, investigations, grading and treatment of Diabetic Foot Ulcer- DFU
• I hope this video is interesting and also useful to all of you
• You can watch the video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
This document provides guidance on taking care of babies' and toddlers' feet. It discusses keeping feet clean and dry, cutting toenails straight across, allowing babies to go barefoot when possible, ensuring shoes fit properly with room for growth, and knowing when to see a specialist for foot issues. Common foot conditions seen in children like flat feet and bowlegs are also mentioned. The document emphasizes the importance of foot health and development in babies and kids.
This document discusses foot care for people with diabetes. It notes that diabetes can lead to poor circulation and nerve damage in the feet, resulting in symptoms like numbness, pain, and slow healing. It emphasizes the importance of daily foot inspections for any wounds, cracks, or infections, as well as keeping feet clean and dry. The document also stresses that people with diabetes should have their feet professionally examined annually and report any changes immediately to prevent foot complications like ulcers and amputation. Proper footwear and blood sugar control are also highlighted as important for foot health.
Osteoarthritis is the most common form of joint disease worldwide, typically affecting older individuals over 70 years of age. It results from mechanical and biochemical insults that exceed the joint's ability to repair itself. The disease causes the breakdown of cartilage in joints like the hips, knees, spine, hands and feet. Key pathological features include the loss of articular cartilage and sclerosis of underlying bone. Risk factors include age, genetics, obesity, previous injury and occupational factors. Symptoms include pain, stiffness and reduced mobility. Management involves symptomatic therapies like exercise, weight loss and braces as well as surgical options like joint replacement for severe cases.
This document discusses risk factors, causes, signs, and management of diabetic foot ulcers. It notes that peripheral neuropathy and vascular disease increase risk by impairing sensation and blood flow. Ulcers form where calluses or bony deformities concentrate pressure. Evaluation includes wound culture and imaging to check for osteomyelitis. Treatment involves wound debridement, offloading pressure, and antibiotics for infection. Surgery may be needed for uncontrolled infection, amputation, or deformity correction. Regular foot screening and appropriate footwear can help prevent ulcers.
This document discusses the pathophysiology and management of diabetic foot. It covers the epidemiology, risk factors, classification, pathogenesis involving neuropathy, infection, ischemia, and biomechanics. It also describes the clinical evaluation including history focusing on previous foot problems and risk factors, and physical examination assessing neuropathy, infection, and ischemia. Thorough examination of the foot and wound is important to guide appropriate management.
This document provides information about amputation procedures. It describes the indications for amputation, including peripheral vascular disease, diabetic limb disease, trauma, infection, malignancy, and deformity. The goals of amputation are to return the patient to maximum function, ablate diseased tissue, reduce morbidity and mortality, and produce a physiological end organ. Different types of amputations are described for the toes, feet, legs, arms, and limbs. Principles for determining the amputation level and performing the procedure are outlined. Postoperative management focuses on wound healing, edema control, pain management, and rehabilitation to prevent contractures. Potential complications are also reviewed.
This document discusses the approach to diabetic foot problems. It defines diabetic foot as a disease involving neuropathy, angiopathy, and infection leading to tissue breakdown and possible amputation. Diabetic foot affects 15% of Jordan's diabetic population and can result in ulcers, osteomyelitis, and amputation. Proper assessment involves examination of the skin, nerves, blood vessels, and any wounds or infections. Treatment requires a multidisciplinary team approach involving different medical specialties.
Osteoarthritis is the most common form of arthritis that affects the joints, especially in those over 45 years old. It involves the breakdown of cartilage in the joints which leads to pain, stiffness, and reduced mobility. Risk factors include age, genetics, joint injuries, and obesity. Symptoms may include joint pain, stiffness, swelling, and grinding sensations. Diagnosis involves physical exams, x-rays showing cartilage loss and bone spurs, and ruling out other causes. Treatment focuses on reducing pain and inflammation with medications and physical therapy, as well as weight loss and joint protection. For severe cases, surgical options like joint replacement may be considered.
The document discusses amputation, including definitions, history, indications, types, postoperative care, complications, and special procedures. It notes that amputation involves surgical removal of part or all of a limb through bone or joints. The main indications are trauma, peripheral vascular disease, infection, tumors, and congenital anomalies. Postoperative goals are prompt healing, edema control, pain management, and early rehabilitation and prosthesis training. Complications can include wound issues, infection, phantom pain, and psychological impacts.
ueda2012 predictors of diabetic foot ulcer-d.walaaueda2015
This document summarizes a study examining predictors of outcome for diabetic foot ulcers at Assiut University Hospital in Egypt. The study prospectively followed 100 patients with diabetic foot ulcers for up to one year to determine factors associated with complete healing within that time period. So far, data has been collected on 50 patients. Preliminary results found that 68% of patients were female, with a mean age of 50.76 years. Factors examined included demographics, medical history, foot examination findings, ulcer characteristics, and lab results. The aim is to identify baseline characteristics that can predict poorer outcomes like non-healing of the ulcer.
This presentation discusses diabetic foot complications. It begins with an overview of topics to be covered, including the concept of diabetic foot, its complications like ulcer, neuropathy and arthropathy, infections and amputations, and management through medical and physiotherapy approaches. Diabetic foot refers to any pathology resulting from diabetes and is caused by a triad of ischemia, neuropathy and infection. Complications include ulcers, neuropathy, arthropathy and infections, which can sometimes lead to amputation. The presentation discusses assessment, medications, footwear, bracing, exercises and other physiotherapy techniques for managing diabetic foot complications.
Osgood-Schlatter disease is a common cause of knee pain in children aged 10-15 years, characterized by gradual onset of pain below the kneecap. It is caused by forceful contractions of the quadriceps muscle pulling on the tibial tuberosity via the patellar tendon, which can cause small fractures or inflammation in the growing bone. Diagnosis is typically made clinically based on the age of the patient, location of pain, and tenderness over the tibial tuberosity. Treatment involves reducing activity, pain management, and physiotherapy. The condition is usually self-limiting and resolves within a year as the bone matures.
The document discusses the diagnosis and management of knee osteoarthritis (OA), outlining the epidemiology, risk factors, clinical evaluation including history, physical exam and diagnostic tests, differential diagnosis, and treatment options focused on lifestyle modifications, medications including analgesics and intra-articular injections, and surgery for advanced cases.
Diabetic foot is caused by the interaction of neuropathy, abnormal foot biomechanics, and peripheral arterial disease impairing wound healing. This leads to foot ulcers and infections, which are graded from 0 to 5 based on severity. Management involves glycemic control, footwear modification, wound care, and antibiotics or surgery depending on grade. Preventing and treating diabetic foot complications reduces lower extremity amputations.
Dr. Vinay Jain presented on diabetic foot. Some key points:
1. Diabetes can cause nerve damage (neuropathy), poor circulation (peripheral arterial disease), and foot deformities which make the feet susceptible to ulcers and infection.
2. About 15% of diabetics develop foot lesions in their lifetime, with an amputation rate 15 times higher than non-diabetics.
3. Risk factors for foot complications include long diabetes duration, neuropathy, past ulcer/amputation, and poor blood sugar control.
4. Treatment depends on the severity of the ulcer and includes wound cleaning, offloading pressure (casts, special shoes), surgery if needed, and amputation in
This document outlines the assessment process for diabetes mellitus (DM) and diabetic foot ulcers. It involves collecting demographic data, medical history, and symptoms. A physical exam evaluates multiple body systems including the eyes, skin, limbs, and feet. Feet are examined for deformities, ulcers, skin/nail changes. Ulcers are characterized by location, size, depth, edges, floor, and surrounding skin. Sensation is tested. Joint and muscle function are assessed along with functional mobility.
DIABETIC FOOT ULCER- / SURGICAL WOUNDS
#surgicaleducator #diabeticfootulcer #surgicaltutor #babysurgeon #usmle
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today in this episode I have discussed Diabetic Foot Ulcer- DFU
• It is a complication of Type 2 Diabetes
• I have discussed about the overview, epidemiology, etiopathogenesis, clinical features, assessment, investigations, grading and treatment of Diabetic Foot Ulcer- DFU
• I hope this video is interesting and also useful to all of you
• You can watch the video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
This document provides guidance on taking care of babies' and toddlers' feet. It discusses keeping feet clean and dry, cutting toenails straight across, allowing babies to go barefoot when possible, ensuring shoes fit properly with room for growth, and knowing when to see a specialist for foot issues. Common foot conditions seen in children like flat feet and bowlegs are also mentioned. The document emphasizes the importance of foot health and development in babies and kids.
This document discusses foot care for people with diabetes. It notes that diabetes can lead to poor circulation and nerve damage in the feet, resulting in symptoms like numbness, pain, and slow healing. It emphasizes the importance of daily foot inspections for any wounds, cracks, or infections, as well as keeping feet clean and dry. The document also stresses that people with diabetes should have their feet professionally examined annually and report any changes immediately to prevent foot complications like ulcers and amputation. Proper footwear and blood sugar control are also highlighted as important for foot health.
This document discusses falls prevention in older adults. It notes that aging changes walking patterns, increasing risks of falling due to slower walking, unsteady balance, reduced toe clearance and other vision and health issues. Common risks include arthritis, balance problems, poor eyesight and foot issues. The document recommends regular exercise focusing on balance, strength, and walking. It also stresses the importance of foot care including nail trimming and podiatrist visits. Proper footwear fitting is important to provide support and cushioning to prevent falls from trips or slips.
This document contains a comprehensive diabetes foot exam form. It collects information on a patient's medical history including diabetes control and complications, foot examination findings, risk categorization, footwear assessment, education provided, current problems, and treatment plan. Exam findings include sensory examination, nail assessment, pedal pulses, musculoskeletal deformities, calluses, wounds, and skin and nail infections. The treatment plan and follow up duration are also documented.
This document discusses various religious and cultural symbolism associated with feet throughout history. It covers topics like feet in the Bible being associated with humility, status before God, and spreading the gospel. Specific passages are referenced that talk about removing shoes as holy ground, feet representing the faithful, beautiful feet of those who preach, foot washing as a custom, and Jesus washing the disciples' feet. Metaphors of feet representing authority, domination, and following righteousness are also mentioned.
Ophthalmic Wound Care Assessment Chart Tracy Culkin
This document contains forms for assessing wounds and developing treatment plans. It includes sections to document factors that could delay healing, mark the location and type of wounds on diagrams of the front and back of the body as well as the feet, note who the patient was referred to for additional treatment, and the assessor's signature and date. Subsequent pages include areas to document details of wound assessments over time such as dimensions, tissue type, exudate levels, peri-wound skin condition, signs of infection, treatment objectives, and wound treatment plans and evaluations. The final page is for evaluating pressure care with sections for the Braden score, pressure relief methods, dressing/cushions used, positioning frequency, and rationale for changes
Assessment Chart for Wound Management Patient ID LabelTracy Culkin
This document contains forms for assessing wounds and developing treatment plans. It includes sections to document factors that could delay healing, mark the location and type of wounds on diagrams of the front and back of the body as well as the feet, note who the patient was referred to for additional treatment, and the assessor's signature and date. Subsequent pages include areas to document details of wound assessments over time such as dimensions, tissue types, exudate levels, peri-wound skin condition, signs of infection, treatment objectives, and wound treatment plans and evaluations. The final page is for evaluating pressure care with sections for the Braden score, pressure relief methods, dressing/cushions used, positioning frequency, and rationale for changes
1362397244 patient self care program prev.ulcerdfsimedia
This document provides information on prevention of diabetic foot ulcers through a self-care program. It discusses how neuropathy, deformities, and minor trauma can lead to foot ulcers in diabetic patients. Regular foot exams are important to check for common problems like dry skin, calluses, and infections early. Daily foot care including inspection, cleaning, nail trimming, moisturizing, and proper footwear can help prevent ulcers and amputations. Risk factors like smoking, poor control, and peripheral vascular disease increase the risk of ulcers and recurrence.
Gill Spyer has completed and presented a retrospective audit looking at those patients who have ended up having an amputation to see if they had appropriate prior access and referral to the integrated foot service. Here are the results and recommendations.
The document is a summary report of findings from the National Diabetes Footcare Audit (NDFA) in England and Wales for 2014-2015. Some key findings from the NDFA include:
- Over 5,000 people with diabetic foot ulcers were included in the audit. About 10% had more than one ulcer and 5% had Charcot foot disease. Over 80% had lost sensation in their feet.
- People with diabetic foot ulcers were just as likely to have received an annual foot check as other people with diabetes according to the NDFA findings.
- The report provides recommendations to healthcare professionals and people with diabetes to improve foot care services and self-management based on the audit results.
This guideline provides 25 recommendations for diagnosing, assessing prognosis, and treating peripheral artery disease (PAD) in patients with diabetes and foot ulcers or gangrene. It was developed by an international collaborative group and is based on systematic reviews of the literature. The recommendations cover diagnosing PAD, assessing likelihood of healing and amputation risk, deciding when revascularization is needed, choosing between endovascular and surgical procedures, post-procedure care, and general risk factor management. The goal is to help clinicians provide better care and reduce complications from diabetes-related foot disease.
CAHPO 2016. Workshop 4: Chris Pankhurst and Lawrence AmbroseNHS England
Chief Allied Health Professions Officer’s Conference 2016
Workshop 4: Supporting self-care and behaviour change – Chair Linda Hindle
Foot assessment and foot self-care app. Chris Pankhurst, Guy’s and St Thomas’ NHS Foundation Trust.
Lawrence Ambrose. Lead Policy Officer, Society of Chiropodists and Podiatrists.
This document provides instructions and materials for healthcare providers to conduct diabetes foot exams. It was produced by the National Diabetes Education Program (NDEP), which is a partnership between the National Institutes of Health and Centers for Disease Control and Prevention. The document includes tools for conducting visual foot inspections and annual comprehensive foot exams, forms for documenting exam results, and patient education materials about proper foot care. It aims to help providers prevent diabetes-related foot problems and lower extremity amputations through early identification of issues, patient education, and treatment when needed.
Kate Hunter authored a clinical guideline on Henoch-Schonlein Purpura (HSP) in September 2012. The guideline provides information on HSP including that it is the most common vasculitis of childhood, affecting small blood vessels. It outlines the diagnostic criteria, typical presentation involving skin, joints, gastrointestinal and renal systems. Treatment is generally supportive with analgesics and monitoring for kidney involvement. Prognosis is typically good with resolution within 6 weeks, though 1% may progress to long-term kidney impairment requiring monitoring for up to a year.
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the latest guidelines ACR and EULAR, Ahmed Yehia Ismaeel, MD Beni-Suef University
ACR EULAR CLASSIFICATION CRITERIA FOR GOUT
EULAR 2023 Guidelines on gout imaging
ACR guideline recommendations for gout management
IRJET- Foot Care Sandal for Diabetic Patients Monitoring by using Lab View So...IRJET Journal
This document describes a system developed to monitor foot pressure in diabetic patients using flexible force sensors and LabVIEW software in order to detect foot ulcers early. Diabetic foot ulcers are common and increase the risk of infection and amputation if not addressed promptly. The proposed system measures foot pressure with flexible force sensors connected to a data acquisition system in LabVIEW. This allows monitoring pressure levels in real-time and detecting pressures above a set threshold to identify high-risk areas and prevent ulcer formation. The system aims to screen for ulcers earlier than traditional methods to improve outcomes for diabetic foot health.
This document provides guidelines for preoperative patient assessment and fasting. It outlines conducting a thorough history and physical exam to determine the patient's surgical risks and optimize perioperative care. Key parts of the assessment include the patient's medical history, medications, allergies, review of systems, and fitness classification. Recommended preoperative tests vary based on the patient and surgery. Fasting guidelines differentiate clear liquids, which require only a 2 hour fast, from solid foods and milk requiring at least a 6 hour fast prior to anesthesia.
The webinar was titled “Breed Health Improvement: finding the balance” and was a talk about approaches to breed health improvement and why every breed needs a health strategy.
1) 6,000 amputations take place in England each year due to diabetes complications costing £600M. The document proposes an intelligent care plan mobile application to help diabetic patients better monitor and control their health.
2) The application would provide daily monitoring of key health risks, education, social support and access to clinical care to help patients bring their diabetes under control to prevent complications like foot ulcers and amputations.
3) Currently treating diabetic patients with severe complications costs tens of times more than non-diabetic patients, ranging from £50,000 to £289,831 per operation. The proposed application aims to provide integrated care for £1480 per patient per year to achieve better outcomes at lower costs
Diabetic peripheral neuropathy is a common complication of diabetes that causes numbness and sometimes pain in the hands and feet. Long-term high blood glucose levels associated with uncontrolled diabetes can damage nerves over time. Symptoms include burning, tingling, and reduced sensation. Foot complications from neuropathy are a major cause of morbidity and can lead to foot ulcers and amputation if not properly managed. Regular screening for neuropathy and other foot problems along with patient education on proper foot care can help reduce risks of ulcers and amputations.
The document discusses diabetic foot complications, which are common, serious problems that negatively impact patient health and society costs. Most complications can be prevented through blood sugar control and daily foot care. Screening high risk groups allows early detection. Treatment requires a multidisciplinary team and specialized care centers. The prognosis is best when complications are identified and managed early.
Every healthcare contact is a health improvement opportunity but how well do we embed lifestyle advice in our day‐to‐day encounters? Gain a greater
awareness and understanding of the Health Promoting Health Service and how we can implement this activity in your workplace.
The document discusses diabetes risk assessment that can be performed in dental offices. It provides background on the presenters and objectives of assessing diabetes risk. Key points covered include the importance of recognizing diabetes symptoms, common risk factors, and diagnostic tests for diabetes and pre-diabetes that can help identify undiagnosed cases. A dual testing method combining fasting glucose and HbA1c is proposed to improve diabetes detection rates.
This document describes a heart disease and stroke prevention program from Cenegenics Medical Institute. The program uses advanced testing methods like genetic screening, ultrasound scans, and blood/urine biomarkers to comprehensively assess cardiovascular risk factors beyond what standard tests provide. It aims to prevent heart attacks, strokes, and other issues by identifying risks early. The evaluation involves blood draws, scans, and a physician consultation to review results and create a prevention plan. The program highlights its unique combination of advanced testing from partner laboratories to provide the most thorough risk assessment available.
Chair and Presenters Kathleen N. Moore, MD, MS, Floor J. Backes, MD, and Bhavana Pothuri, MD, MS, prepared useful Practice Aids pertaining to endometrial cancer for this CME/MOC/NCPD/AAPA/IPCE activity titled “Redefining Endometrial and Ovarian Carcinoma Care: Maximizing the Clinical Potential of Immunotherapy, ADCs, PARP Inhibitors, and Other Emerging Treatment Strategies.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at https://bit.ly/3SjJyuH. CME/MOC/NCPD/AAPA/IPCE credit will be available until April 17, 2025.
The document discusses the origins and traditions of Hogmanay, the Scottish New Year's celebration. It traces the roots of Hogmanay to ancient Celtic winter festivals like Samhain that celebrated the new year on November 1st. Traditions discussed include first-footing, where the first visitor of the new year brings luck; foods eaten for good fortune; and the singing of Auld Lang Syne. The banning of Christmas in 16th century Scotland by John Knox helped establish Hogmanay as the main end of year celebration.
The document provides a brief history of Christmas traditions and their origins. It traces how winter solstice celebrations in ancient Egypt, Babylon, Rome and Celtic traditions incorporated Christian elements over time. Decorating with greenery, gift giving, feasting and lighting candles can be traced back to pagan winter festivals celebrating the return of longer days. The Christmas tree tradition originated from Germany and the Puritans banned Christmas celebrations in England in the 1600s before it was revived. Carols, cards, crackers and other modern traditions developed through the 19th century.
Women have played forms of soccer since the 17th century in Scotland, but it was not until the late 19th century that organized women's soccer emerged. The first international match was in 1881 between England and Scotland. Women's teams in the early 20th century helped promote women's suffrage. During World War 1, women's soccer grew as women worked in factories. However, soccer associations banned women's soccer in the 1920s. It continued locally until the 1970s when national and international governing bodies began to officially support and organize women's soccer competitions.
The document summarizes the origins and evolution of Santa Claus figures from various cultures. It describes figures like Saint Nicholas who gave gifts to poor families in Turkey in the 4th century AD. It then discusses traditions from countries like Germany, France, Spain, Italy, and Russia that involved gift-giving near Christmas by figures like Father Christmas, Christkind, Balthazar, La Befana, and Babouschka. It outlines how Santa was depicted in American artwork and advertisements over time, from Thomas Nast's political cartoons to Norman Rockwell paintings to Coca-Cola ads cementing the modern image of Santa.
Sneakers: From sandshoes to bluechip record breakers Cameron Kippen
This document provides a history of sneakers/trainers from their origins in the 1800s as rubber-soled canvas shoes for beach activities, to their modern use as high-fashion and sports performance footwear. It traces key developments like the introduction of rubber soles, celebrity endorsements boosting popularity, and the rise of sneaker collecting. The summary highlights how sneakers evolved from casual sandals to multi-billion dollar cultural icons through technological advances, popularity in sports, and clever marketing exploiting youth culture.
This document provides a brief history of eight types of shoes from over 15,000 years ago to modern times. It traces the evolution of basic foot coverings made of animal skins to specialized crafting of leather shoes. Key developments included the use of needles for sewing around 10,000 years ago, the addition of heels by horse-riding cultures, and changes due to wars, industrialization, and consumer demand. Sumptuary laws historically regulated dress and footwear to reinforce social hierarchies. The document focuses on how various cultures influenced shoe fashion over millennia.
Plimsolls, which were canvas shoes with rubber soles, originated in the late 1800s as inexpensive shoes worn by families visiting the seaside. Over time, plimsolls evolved and were adapted for different sports like tennis, eventually becoming early sneakers and tennis shoes. In the 1900s, brands like Converse and Keds rose to popularity among teenagers and sneaker culture continued to grow with limited editions and celebrity endorsements fueling the collecting market today, with some rare sneakers selling for over $100,000.
1) Shoes have evolved over thousands of years from simple sandals to address needs like protection, decoration, and modesty. Prehistoric finds show a variety of early shoe styles.
2) Throughout history, fashion trends and shoe styles were influenced by factors like military use, religion, courtly love traditions, and disease outbreaks. Long-toed shoes and platforms may have served practical sexual purposes.
3) Major forces shaping modern footwear include Hollywood, world wars, the space race, and new technologies enabling high performance and injury prevention. Biomechanics research optimizes shoe design.
Boots have been worn for over 17,000 years, as evidenced by cave paintings from 15,000 BCE depicting humans wearing skin and fur boots. Early boots were likely made of felt or leather and held together with bone needles or flint awls. Throughout history, boot designs evolved for different purposes and cultures, from finely crafted Persian boots to the modern cowboy boot. Major developments included the introduction of hobnails by the Romans and Etruscans, the popularization of the Wellington boot after the Napoleonic Wars, and the emergence of distinct cowboy boots in the American West by the 1880s.
From antiquity, footwear became an important status symbol jealously guarded by the ‘well heeled,’ and through to modern history; protected by Sumptuary Laws to prevent upward mobility.
John Lobb became famous for his bespoke bootmaking business after developing a hollow-heeled boot for prospectors in Australia and winning awards for his craft. He eventually moved his business to London. Shoe polish, like Kiwi polish invented in Australia, became important for maintaining footwear and a mark of status. Shoe shining was an occupation that some businessmen rose from, like Malcolm X. The shoe polishing industry has faced issues around child labor and street children.
Indigenous Australians rarely wore shoes, while early European settlers brought shoes that were ill-suited for Australian conditions. Convict shoemakers established the footwear industry in Australia. While American imports dominated in the late 19th century, Australian manufacturers rebounded during the World Wars. Some iconic Australian shoe brands like RM Williams emerged, focusing on practical styles for rural lifestyles. However, most footwear production has now moved offshore, with local manufacturers producing around 12% of shoes purchased in Australia.
Rock shoes:A brief history of Rock Shoes (1956-1990) Cameron Kippen
If there was ever an item of clothing to epitomise the style and fashion of an era it would have to be shoes (or
their absence). The following presentation is a brief review of rock shows in the later part of the 20th Century.
Fetishism & Sexual Variance: A brief reviewCameron Kippen
This document discusses foot and shoe fetishes from a psychological perspective. It defines fetishism and different levels of fetishism intensity. It provides background on theorists like Freud who have studied fetishes. It discusses characteristics of those with paraphilic fetishes and specifics about foot and shoe fetishes. It notes fetishism is often seen as a male phenomenon related to performance anxiety and a way to ease anxiety about sexual acts.
This document presents redesigned posters for each FIFA World Cup from 1930 to 2014 created by designer James Taylor. The original posters on the left tried to represent the host nation's culture while celebrating football. Taylor's redesigns on the right modernize the posters with a consistent style for easy comparison across the tournaments. References are provided for further information on Taylor's posters and the history of World Cup graphic design over 80 years.
This slide presentation outlines a psycho-sexual perspective of shoes. Shoes are intrinsically human and a source of eternal fascination to those who take an interest. The purpose of the presentation is to inform and entertain.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
10. Symmetry
Pivot points and
Pressure areas
Amputation
Muscle wastage
Abnormal gait patterns
11. Size (length and breadth)
Volume
Suitability
Wear marks
12. Low risk i.e. no risk factors with palpable pulses
and normal sensation. Recommend annual foot
examination and education.
Intermediate risk i.e. the presence of neuropathy
or absent pulses or foot deformity . Recommend
review every 3 to 6 months.
High risk i.e. where two or more risk factors are
present (neuropathy, peripheral arterial disease or
foot deformity or a previous history of foot
ulceration . Recommend 3 to 6 months reviews.
Critical risk Referral GP/Hospital within 24 hours
13. Control Blood Glucose
Levels
Annual Foot Screening
Examination
Report change
immediately
Engage in simple daily
foot care
14. Team Care
Arrangements –item
723
General Management
Plan – 721
Enhanced Primary
Care Plan
Community Aids and
Equipment Program
(CAEP)
15. National Evidence-Based Guideline
Prevention, Identification and Management of
Foot Complications in Diabetes April 2011
http://www.nhmrc.gov.au/_files_nhmrc/public
ations/attachments/diabetes_foot_full_guideli
ne_23062011.pdf
Australasian Podiatry Council
http://www.apodc.com.au/
Diabetes Australia
http://www.diabetesaustralia.com.au/
16. WARNING
This material has been copied and communicated
to you by or on behalf of Cameron Kippen
pursuant to Part VB of the Copyright Act 1968
(the Act).
The material in this communication may be
subject to copyright under the Act. Any further
copying or communication of this material by
you may be the subject of copyright protection
under the Act.
Do not remove this notice
Editor's Notes
Diabetes is now recognized as a chronic, debilitating and costly disease, predicted to double to 366 million by 2030. Something like, 47% of diabetics have some peripheral neuropathy and at a conservative estimate, 7.5% are suffering symptoms at the time of diagnosis. Research confirms early detection of the insensate limb is critical, but difficult because diabetic peripheral neuropathy (DPN) is often asymptomatic.Despite clear and authoritative clinical guidelines research also supports first-line providers do not screen enough and their care quality suffers as a result. The purpose of this short presentation is to highlight the podiatrist‘s role in screening the diabetic foot. (102)
I am a firm believer the great maker, (whoever she was), was a podiatrist, or at least a friend of podiatry, for the longer we live the more we seem to rely on the services of others to tend to our feet. All the more critical as the bludgeoning diabetic population becomes endemic among the 45 plus age group. (59)
For my sins, I am a community based podiatrist with a demographic made up of seniors, who are often: sight challenged hypertensive, peripherally ischaemic, venous return compromised, obese with ankle oedema, on anticoagulants, and suffering all manner of arthritides. High percentage are diabetic (and often not taking their medication), with chronic foot problems that limit mobility. Of course there are co-morbidities which collectively make toe nail clipping marginally safer than swimming blindfold slowly through a school of man eating sharks. However I suppose someone has to do it. (88)
Aetiology of diabetic neuropathy is still poorly understood although glycation is probably a major factor. (The importance of glycaemia has been confirmed by studies showing incidence is greatly reduced by strict glycaemic control.) Resultant changes to vasculature also play an important part in causation of nerve damage. Disruption to neuronal integrity and failure to regenerate results in progressive neuropathy characteristically presenting in a distal–proximal direction (stocking distribution). Loss of protective sensation means people unwittingly can damage themselves. Delayed healing and propensity to infection mean small cuts and other abrasions have the potential to ulcerate. It is now recognized regular foot screening helps monitor and prevent serious complications in people coping with peripheral neuropathy and peripheral vascular disease. The clinical conundrum:Some patients present with acute sensory neuropathy i.e. severe polyneuropathic pain i.e. burning, hyperesthesiae, paresthesia, and dysesthesia [an unpleasant, abnormal sense of touch], but with minimal deficit. All prone to nocturnal exacerbation. Clinical examination is usually relatively normal, sometimes with allodynia on sensory testing; a normal motor exam, and occasionally reduced ankle reflexes.Others more commonly present with chronic sensorimotor neuropathy and have a complete insensate foot and no symptoms. This neurological deficit may only be discovered during a routine neurological foot examination. (205)
Currently there is no gold standard for chair side assessment of Diabetic Peripheral Neuropathy (DPN). Conventional wisdom supports symptoms alone have relatively poor diagnostic accuracy hence a combination of signs and symptoms approach is considered more appropriate. Symptoms may be primarily sensory, motor or both. Simple composite examination scores are as accurate as complex examinations. Best evidence supports the use of the 10g monofilament combined with the modified Neuropathy Disability Score (NDS) to chart protective sensation and identify those most likely to progress to ulcerative stage. NDS is a score based on vibration perception, pin-prick sensation, temperature perception, and ankle (Achilles) reflexes. (102)
From the 80s, Semmes-Weinstein monofilament examination (SWME) has been used in testing protective sensation. Initially they were developed to assess neuropathy in Hansen’s disease. At a given pressure to the skin (10 grams) the nylon filament bends. The 5.07 (10g) filament is used to ascertain the level of protective sensation. With eyes closed three sites are tested i.e. the plantar aspects of the great toe, the third metatarsal, and fifth metatarsal (The Australian Diabetes Society). Research suggests people unable feel the monofilament have a 7.7-fold increase in ulceration risk. Monofilaments have high inter and intra examiner reliability and are generally considered effective, inexpensive and simple screening for ‘at risk’ feet.The half -life of a Semmes-Weinstein monofilament is approximately 100 patients. Filaments fatigue and bend too easily, giving false positives after testing about 10 patients. They must be rested for 24 hours before regaining their firmness. (146)
A modified Neuropathy Disability Score (NDS) has been shown to be the most reliable test for sensitivity and grading diabetic peripheral neuropathy. Combination of different examination scores gives better sensitivity and specificity. Diabetic peripheral neuropathy manifests with a wide variety of sensory, motor, and autonomic symptoms. Smaller fibres are often the first to be affected and with continued hyperglycemia, larger fibres follow. The smallest sensory nerves are responsible respectively for thermal/burning pain (0.2-1.5 mu); and sharp pain (1-5 mu). Pin Prick sensation is tested with neurological pins. Altered thermal thresholds such as lowered heat-pain thresholds are associated with early changes in distal nerve segments and can be tested with simple heat/cold tests. Bigger A-alpha (I) and A- beta (II) responsible for propioception (13 -20 mu), vibration and pressure (6 -12 mu). A loss of propioception may result in a positive Romberg’s sign. Vibration Perception threshold is tested using a 128Hz tuning fork or RydellSeiffer tuning fork. Vibration Perception thresholds have a strong co-relation with nerve conduction velocities and are a reliable indicator of “risk” for future ulceration across a wide range of ages and durations of diabetes. (Neurothesiometer or Biothesiometer). Deep tendon reflexes with neuropathy are commonly hypoactive or absent. The maximum NDS is 10, with a score of 6 or more being predictive of foot ulcer risk. (219)Neuropathy Disability Score (normal = 0 abnormal = 1)Vibration Perception Threshold (can distinquish vibration =0 etc)Temperature Perception on Dorsum of Foot hot/cold (can distinguish =0)Pin Prick sharp/blunt (can distinguish = 0) Achilles Reflex (present =0 with reinforcement =1 Absent =1)
Motor weakness is unusual, although small muscle wasting in the feet and also the hands may also be seen in more advanced cases. Motor problems include distal, proximal, or more focal weakness. Symptoms include weakness or atrophy of intrinsic foot muscles and associated foot deformities. Foot slapping and toe scuffing or frequent tripping may be reported. Proximal limb weakness include difficulty climbing up and down stairs, difficulty getting up from a seated or supine position, as well as falls due to the knees giving way. Strength testing - Examine for distal intrinsic extremity muscle atrophy, since weakness of small foot muscles may develop.Autonomic neuropathy may involve the cardiovascular, gastrointestinal, and genitourinary systems and the sweat glands (sudomotor). People with generalized autonomic neuropathies may report ataxia, gait instability, or near syncope/syncope. Sudomotor neuropathy may produce heat intolerance, heavy head, neck, and trunk sweating with anhidrosis of lower trunk and extremities. Signs might include warm dry skin (in the absence of peripheral vascular disease) and the presence of plantar callus under pressure-bearing areas. The “at-risk” foot for neuropathic ulceration might also have a high arch (pescavus) and clawing of the toes. However, it must be emphasized that all patients with DPN with or without obvious foot deformities must be considered as being at risk of neuropathic complications, such as Charcot’s neuroarthopathy or foot ulceration. (127)
Claudication can be a useful symptom, but peripheral arterial disease (PAD) is commonly asymptomatic. Palpation of foot pulses is however a good simple test to determine the presence of peripheral arterial disease. The ankle-brachial pressure index (ABPI or ABI), using Doppler ultrasound is a useful adjunct to assess foot perfusion. Results can however be falsely elevated in the presence of arterial calcification and in this event clinicians are using photoplethysmography the measure toe-brachial pressure index or toe pressures. In the ‘toe’ examination, if the flow is deemed adequate patients are managed medically, surgically, and mechanically with the foci to heal and prevent severe recurrence. If the blood supply is determined to be inadequate, the patient is prioritised for revascularisation or ‘flow’. Once an appropriate blood supply is established the patient is returned to ‘toe’ for preventive management. (137).
A Foot Deformity Score helps identify high risk areas where repetitive trauma can cause breakdown, progressive ulceration, and infection. Screening includes signs such as: abnormal bony prominences, subluxation of the metatso-phalangeal joints, lesser toe deformities due to small muscle wasting, PesPlanus or PesValgus, previous amputation, and Charcot’s neuroarthropathy. About half all amputees experience a subsequent amputation of the other limb. Morbidity rates for limb amputees are poor with a life expectance of approximate five-years.Dryness, tineapedis, cracks, onychomycoses, acute erythema and tenderness, and fluctuance under calluses. (89)
Inadequate footwear makes a significant contributory factor in causation of diabetic ulcers i.e. 35% -50% of cases. Shoes are made in standard sizes and feet are not symmetrical like shoes. Poorly fitting shoes cause sheer which may lead to secondary skin changes.When shoes fail to support feet, high intermittent pressure result which puts the insensate foot at risk. A significant number of people wear shoes that do not fit their feet and research continues to shown poorly fitting shoes are more prevalent in the demographic with diabetic foot wounds than in those without wounds with or without peripheral neuropathy. A routine foot assessment includes size, volume, suitability and wear marks of presenting footwear are reviewed and discussed with the patient. (121)
There are several systems to categorize risk with the best known the University of Texas Diabetic Foot Risk System (with 7 categories). For simplicity however the demographic can be divided into four main divisions: Low risk i.e. normal sensation and palpable pulses. Recommend an annual foot inspection with education. Intermediate risk i.e. neuropathy or absent pulses or foot deformity. Recommend 3 to 6 monthly reviews. High risk i.e. where two or more risk factors are present (neuropathy, peripheral arterial disease or foot deformity) and/or a previous history of foot ulcer/amputation have been recorded. Recommend 3 to 6 monthly reviews.Critical category Recommend GP/Hospital referral within 24 hours. Increased assessment frequency helps monitor rapidly-developing problems, such as ulcers, infections, gangrene, and Charcot’s neuroarthropathy. All of which need immediate intervention. Until adequately assessed all Aboriginal and Torres Strait Islander people with diabetes are considered to be at high risk of developing foot complications and therefore will require foot checks at every clinical encounter and active follow-up. (164)
The CARE approach has been accepted by many health care systems across the Western World. In Australia the Enhanced Primary Care Plan gives greater access to clients who are potentially at risk. Foot Health Education Programs promote daily self foot inspections with informed foot hygiene that minimize inadvertent self harm. Advice on appropriate foot gear and where to get it is combined with and open access in the case of emergency. (71)
Early detection of the insensate limb is critical and improved Quality Adjusted Life Years is achieved through regular foot screening and foot care; in conjunction with intensive glycaemic control. To this end effective care involves clear communications between patients and other health care professionals. I hope this presentation will convince you to use podiatry services to improve the quality of care to our diabetic population. (65)