Diabetic foot complications can include foot ulcers and Charcot foot. Physiotherapy focuses on prevention through proper foot inspection, care, and appropriate footwear. Treatment for foot ulcers includes wound offloading, improving sensation, electrotherapy like laser and TENS, negative pressure therapy, oxygen therapy, and exercises. More advanced ulcers may require surgery. Charcot foot management involves weight bearing restrictions, custom bracing, immobilization, electrotherapies, exercises like mobilization and strengthening, and gait re-education.

1. Diabetic Foot
Presented by :
Upasana Agarwal
BPT 4th year

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DEFINITION :
 Any trauma in presence of neuropathy and/or peripheral vascular
disease may lead to formation of :-
 Foot Ulcer
 Charcot Neuropathy

3. Physiotherapy Management
✧ Involves in both the prevention and managements of diabetic
foot complications.
✧ Two parts :
FOOT ULCER
 Results from
trauma,
 Unnoticeable
due to loss of
sensation
CHARCOT FOOT
 progressive
condition
 Subluxation,
dislocation,
pathological
fracture

4. PREVENTIONS
FOOT ULCER
1. Proper inspection of the foot by the patient
2. Proper care of thr foot
3. Choosing correct shoes and socks
TREATMENTS
1. Depends on the stages of ulcer.
2. Stage - 1 to 4
3. Stage - 5

5. FOOT ULCER
INSPECTION
1. Teach the patient to inspect his own foot by
using mirror or taking someones help.
2. Check - swelling, in between the toes.
3. Check the pressure points of the foot.
4. Also teach the patient to check the sensation
like light touch.

6. FOOT ULCER
CARE
1. Proper hygiene should be maintained by the
patient - washing, drying
2. Proper moisturization of foot
3. Correct way of cutting nails
4. Keep your feet warm - using warm socks and
shoes.
5. Don't get the feet wet for long time.
6. Avoid cross leg sitting.

7. FOOT ULCER
SHOES AND SOCKS
1. Proper covering of the foot.
2. Wear covered shoes
3. If new shoes- wear only for 2 hours
4. No tight shoes or socks should be used
5. Never walk barefoot.
6. Wear one size bigger shoes and socks

8. FOOT ULCER
STAGE - 1 TO 4
1. Cover with gauze piece but don't
compress
2. Wound off loading - achieved by shoe
modifications, boots and orthotic walkers.
3. Improve the sensation - using hard and
soft scrubs, heat and cold sensations,
low intensity farradic current.

9. FOOT ULCER
STAGE - 1 TO 4
ELECTROTHERAPY
 Laser therapy - low level
laser(5mW-500mW) for 10-15
mins/session.
 UST - 0.8-1w/cm2 intnsity for 5-10
mins.
 Galvanic current stimulation - 1 Ma
intensity for 20 mins.
 ESWT - energy level of
0.03mjoul/mm2 30 mins per foot
twice weekly.
 TENS, cryotherapy
NEGATIVE PRESSURE THERAPY
 Helps in fast healing of ulcer.
 Uses controlled negative pressure
using vacuum assisted closure(VAC)
device

10. FOOT ULCER
STAGE - 1 TO 4
OXYGEN THERAPY
 Topical oxygen
 Systemic oxygen - hyperbaric
oxygen is administered in a
compression chamber which
provides 100% oxygen.
EXERCISES
 Ankle ROM (mainly the dorsiflexion)
 Stretching exercises
 Strenghtening exercises
 Proprioception and balance
training
 Buerger - Allen exercise

11. Buerger Allen Exercise
Proprioception & Balance

12. FOOT ULCER
STAGE - 5
 All treatments for stage - 1 to 4
are also done in stage - 5
 Needs surgical treatments -
skin graft, debridement.

13. PREVENTIONS
CHARCOT FOOT
1. Proper inspection of the foot by the patient
2. Proper care of thr foot
3. Choosing correct shoes and socks
4. Avoid weight bearing on the affected limb.
5. Avoid injury, such as bumping the foot or
overdoing exercise

14. TREATMENTS
CHARCOT FOOT
1. Weight loss - to decrease pressure on
foot
2. Custom shoes and bracing - with insoles.
Shoes with rocker bar reduces the ground
reaction force and facilitate the push off
phase.
3. Immobilization - complete non-weight
bearing is necessary.
4. Painful stimulation - on sole of foot.

15. TREATMENTS
CHARCOT FOOT
ELECTROTHERAPY
 UST - for pain relief, non-thermal
 TENS - burst
 IFT
 Cryotherapy
 Faradic muscle contraction
 Long wave diathermy
 contrast bath

16. TREATMENTS
CHARCOT FOOT
EXERCISE THERAPY
 Joint mobilization - low glides like
Talar glides.
 Massage - with pressure
 Ankle ROM
 Stretching and strengthening
exercises
 Gait re-education
 Balance training
 Taping

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Thank you