Recommended
Recommended
More Related Content
Similar to Risk Assessment and Stratification Diabetic Foot.pptx
Similar to Risk Assessment and Stratification Diabetic Foot.pptx (20)
Recently uploaded
Recently uploaded (20)
Risk Assessment and Stratification Diabetic Foot.pptx
- 1. Dr. Adheesh Phalke Diabetic Foot Risk Assessment Presented by- Dr. Adheesh Phalke
- 2. Dr. Adheesh Phalke In India; - >66.8 million diabetics in age group 20-70 - 8.6% prevalence of diabetes - 25% lifetime risk of diabetic foot ulcer - 15% people with Diabetes duration >=10yrs - one of the most common complications Diabetic foot : “ foot of a diabetic person, that has potential risk of pathological consequences, associated with neurologic | vascular | metabolic complications of diabetes in lower extremity “ -W.H.O Globally; - 34% lifetime risk of diabetic foot ulcer - Incidence 18.6 million people per year - 2.5 fold higher risk of death than a diabetic without ulcer - most frequently complicated by infection
- 3. Dr. Adheesh Phalke - Screening for DFU risk is essential for early identification of it’s components; thereby preventing progression to advanced complications Vascular factors Mechanical factors Compounded by; - diabetic neuropathy; sensory | motor | autonomic - peripheral arterial disease - trauma / precipitating event Development of DFU typically involves; interplay
- 4. Dr. Adheesh Phalke Adopted | Adapted from four source guidelines IWGDF-2015 | IDSA 2012 | NICE 2015 | NICE guidelines on PAD 2014 MoHFW Standard Treatment Guidelines Recommendations: - Identifying “at-risk” foot - Regular inspection, examination of “at-risk” foot - Educate patient | family | healthcare provider - Use of appropriate footwear - Treatment of pre-ulcerative signs
- 5. Dr. Adheesh Phalke A ssessment R ecommendat ions Screen in history; Lower extremity amputation | revascularisation Peripheral Arterial Disease Foot deformity Foot Ulcer(s) Poor foot hygiene Ill-fitting footwear Patient as a whole Evaluate diabetic patient, presenting with foot wound, at three levels Affected foot | limb Infected wound Assess affected foot | limb for: arterial ischemia - venous insufficiency - loss of protective sensation - biomechanical problems
- 7. Dr. Adheesh Phalke Risk classification system and Preventive screening frequency Consider possibility of infection occurring in any foot wound, in diabetic patient
- 8. Dr. Adheesh Phalke Risk grading for infected diabetic foot ulcer
- 9. Dr. Adheesh Phalke Consider vascular imaging and revascularization in DFU with PAD, if ulcer does not improve in 6weeks, despite op Ankle systolic pressure Ankle-Brachial pressure index Evaluate entire lower limb arterial circulation Colour doppler studies Doppler arterial waveform Evaluate patient with diabetes and foot ulcer for presence of Peripheral Arterial Disease Palpating pedal | limb pulses History History of claudication Assess severity of diabetic foot infection and factors suggestive of need for hospitalisation
- 10. Dr. Adheesh Phalke Guidelines for prevention | assessment | management of Diabetic Foot disease Limb related Patient related LOPS PAD End Stage Renal Failure Ulcer related area depth site single/multiple infection presence Based on 8 key factors
- 11. Dr. Adheesh Phalke (i) SINBAD system quick, simple to apply no need of specialised equipment beyond clinical assessment allows for triage high inter-observer reliability Grades the area | depth | arteriopathy | denervation| infection
- 12. Dr. Adheesh Phalke A strong predictor of need for hospitalisation (ii) IDSA / IWGDF system to characterised and guide infection management in a diabetic patient with infected foot ulcer
- 13. Dr. Adheesh Phalke (iv) WIFI scoring to assess perfusion and likelihood benefit from revascularisation
- 14. Dr. Adheesh Phalke Uses combination of scores for wound | ischemia | foot infection 1 yr risk of amputation 1 yr benefit for revascularisation To provide
- 15. Dr. Adheesh Phalke New model to classify patient with, diabetes | active DFU, by the risk for lower extremity amputation Having in it’s foundation, IWGDF diabetic foot risk assessment
- 16. Dr. Adheesh Phalke Four DFU Previous foot complications depth extent infection number Four foot Uses 8 variables Foot Deformity Peripheral Arterial Disease Peripheral Neuropathy
- 17. Dr. Adheesh Phalke IWGDF risk stratification to predict foot ulcer in diabetic patients American Diabetes Association Approach :
- 18. Dr. Adheesh Phalke History; duration of diabetes overall glycemic control prior foot injury | ulcers | amputation | revascularisation claudication history cigarette smoking Visual inspection of feet at each visit inclusive of; nail care | footwear | fungal infections | callosities - 10g monofilament testing @12sites - Ipswich touch test - Vibration testing; 128Hz tuning fork [or] biothesiometer Inspection - skin integrity - bony deformities - joint mobility - gait | balance - Charcot arthropathy Loss of Protective Sensation Foot Examination Pedal pulses - pulse - temperature - dependant rubor - claudication - Ankle-Brachial Index
- 19. Dr. Adheesh Phalke If ulcer present - drainage - odour - granulation tissue - exposed underlying structures - infection site | size | depth | extent | number | health | infection
- 22. Dr. Adheesh Phalke DIAPHORA ADA guidelines Peripheral Arterial disease -palpable pulses -Colour doppler CT Angiography MR Angiography Peripheral Neuropathy LOPS - 10g Monofilament - 128Hz tuning fork vibration sense Thorough visual assessment along with footwear review History of previous foot complaints Foot Deformity - X-Ray - CT/MRI INLOW’S WIFI DIABETIC FOOT ASSESSMENT SINBAD Take Home Message
- 23. T h a n k Y o u .