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Diabetic foot lecture 2010
The document discusses diabetic foot complications, including: 1) Diabetic foot ulcers affect 1-4% of diabetics annually and have a 15-25% lifetime risk, with 15% resulting in lower extremity amputation. 2) Risk factors for diabetic foot ulcers include peripheral neuropathy, a major contributing factor. Comprehensive foot exams assess dermatological, nerve, osseous, and vascular risks. 3) Current treatments include addressing dry skin, fungal infections, calluses, ulcers, and more through debridement, dressings, offloading, and advanced therapies like skin grafts and platelet-rich plasma.
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Diabetic foot lecture 2010
- 1. Diabetic Foot Complications– Current treatments and advanced therapies in treating the diabetic foot Don Pelto, DPM Central Massachusetts Podiatry, PC Worcester, MA
- 2. Objectives Participants willunderstand 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. 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. Diabetic Foot UlcersOne 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 amputation 3,5 ~85% of lower limb amputations in patients with diabetes are preceded by ulceration 6-7 Peripheral neuropathy is a major contributing factor in diabetic foot ulcers 1-7 1. Reiber and Ledoux. In The Evidence Base for Diabetes Care. Williams et al, eds. Hoboken, NJ: John Wiley & Sons; 2002:641–665. 2. Boulton et al. NEJM. 2004;351:48. 3. Sanders. J Am Podiatry Med Assoc. 1994;84:322. 4. Boulton et al. Lancet. 2005;366:1719. 5. Ramsey et al. Diabetes Care 1999;22:382. 6. Pecoraro et al. Diabetes Care. 1990;13:513. 7. Apelqvist and Larsson. Diabetes Metab Res Rev. 2000:16:S75.
- 5. Costs to Treata 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. 5-Year Mortality RatesArmstrong 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. 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. Current and AdvancedTreatments for Wounds
- 9. Dermatological Considerations DrySkin Fungal Infection Callus Interdigital lesions Ingrown Nail Ulceration
- 10. Dermatological Considerations DrySkin Fungal Infection Callus Interdigital lesions Ingrown Nail Ulceration
- 11. Dermatological Considerations DrySkin Fungal Infection Callus Interdigital lesions Ingrown Nail Ulceration
- 12. Dermatological Considerations DrySkin Fungal Infection Callus Interdigital lesions Ingrown Nail Ulceration
- 13. Dermatological Considerations DrySkin Fungal Infection Callus Interdigital lesions Ingrown Nail Ulceration
- 14. Dermatological Considerations DrySkin Fungal Infection Callus Interdigital lesions Ingrown Nail Ulceration
- 15. Dermatological Considerations DrySkin Fungal Infection Callus Interdigital lesions Ingrown Nail Ulceration
- 16. Dermatological Considerations DrySkin Fungal Infection Callus Interdigital lesions Ingrown Nail Ulceration
- 17. Dermatological Considerations DrySkin 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. Dermatological Treatments CallusDiabetic 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. Dermatological Treatments CallusDiabetic 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. Dermatological Treatments CallusDiabetic 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. Dermatological Treatments CallusDiabetic shoes Ulceration VAC Debridement Dermal Skin Substitute Platelet Rich Plasma
- 22. Dermatological Treatments CallusDiabetic shoes Ulceration VAC Debridement Dermal Skin Substitute Platelet Rich Plasma
- 23. Dermatological Treatments CallusDiabetic shoes Ulceration VAC Debridement Dermal Skin Substitute Platelet Rich Plasma
- 24. Nerve Considerations NeuropathySemmes Weinstein 5.07 monofilament (10g) EMG and NCV
- 25. Nerve Treatments NeuropathyMedication Oral Topical Medication ENFB (Epidermal Nerve Fiber Biopsy)
- 26. Musculoskeletal Considerations FootDeformities Plantar Pressure Charcot Joint
- 27. Musculoskeletal Considerations FootDeformities Plantar Pressure Charcot Joint
- 28. Musculoskeletal Considerations FootDeformities Gait Evaluation Plantar Pressure Charcot Joint
- 29. Musculoskeletal Treatments FootDeformities Preventative foot surgery
- 30. Vascular Considerations PulsesCapillary filling time Color changes Edema Temperature
- 31. Vascular Considerations PulsesRevascularization Silverhawk Vascular flaps
- 32. Shoegear Considerations Typeof shoe Fit Lining Wear Insoles, Orthoses Socks
- 33. Shoegear Modifications Diabeticextra-depth shoes Diabetic socks Multi-density inserts
- 34. Thank You DonPelto, DPM Central Massachusetts Podiatry, PC Worcester, MA 508.757.4003 [email_address]
Editor's Notes
- #2 Say may ask questions during presentation. Speak slowly.
- #8 RCTs evaluating education for people with diabetes, aimed at preventing diabetic foot ulceration, are mostly of poor methodological quality. Weak evidence suggests that patient education may reduce foot ulceration and amputations, especially in high-risk patients. Foot care knowledge and behaviour of patients seem positively influenced by patient education in the short term.
- #18 Prevention 4 RCTs of pressure relieving interventions were identified. Interventions for the prevention of diabetic foot ulcers indicated that in-shoe orthotics are of benefit. The relative merits of different in-shoe orthotics are unclear; cushioning and pressure redistribution appear of equal benefit. Other pressure relieving interventions such as running shoes have not been adequately evaluated and removable casts (Scotchcast or Hope) or foam inlays do not appear to have been evaluated at all in randomised controlled studies. Treatment 1 RCT of total contact casting indicated that it was effective in the treatment of diabetic ulcers although the evidence was limited .
- #20 Topical negative pressure therapy for treating chronic wounds Topical negative pressure (TNP) therapy is the application of negative pressure across a wound to aid wound healing. The pressure is thought to aid the drainage of excess fluid, reduce infection rates and increase localised blood flow. TNP is also known as vacuum assisted closure (VAC) and sealed surface wound suction. Seven trials compared TNP with either moistened gauze dressings or other topical agents and found no difference in effects. One very small, poor quality trial (7 wounds) showed a reduction in wound volume and depth in favour of TNP. There is no valid or reliable evidence that topical negative pressure increases chronic wound healing.
- #21 There is evidence to suggest that hydrogel increases the healing rate of diabetic foot ulcers compared with gauze dressings or standard care and larval therapy resulted in significantly greater reduction in wound area than hydrogel. More research is needed to evaluate the effects of a range of widely used debridement methods and of debridement per se.
- #23 12 Weeks Sheehan 2003 Diabetes Care
- #25 Bring Semmes Weinstein tester and vibration tester
- #26 Affects C Fibers and A delta (small ones first)
- #28 Bring in pressure stat
- #29 Before and after
- #34 Bring DM shoe with inserts