diabetic foot ulcer etiopathogenesis & management

1. DIBETIC FOOT ULCER
ETIO-PATHOGENESIS &
MANAGEMENT
DR.ARUN BAL
S.L.RAHEJA HOSPITAL

2. METHOD OF OFF-LOADING
• BEDREST
• CRUCTHES
• WHEELCHAIR
• SPECIAL FOOTWEAR
• CONTACT CASTING

3. MECHANISM OF INJURY
• DIRECT PENETRATION OF SKIN
• SMALL AMOUNT OF FORCE
SUSTAINED OVER A PERIOD OF
TIME
• MODERATE AMOUNT OF
REPATATIVE FORCE

4. INDICATION OF
WORSENING INFECTION
• INCREASED DRAINAGE
• INCREASED ERYTHEMA
• SUDDEN INCREASE IN PAIN
• INCREASED WARMTH
• FOUL ODOUR
• LYMPHANGITIS

5. INDICATION OF WORSENING
INFECTION(CONT)
• INCREASED BLOOD GLUCOSE LEVEL
• INCREASED WBC LEVEL
• INCREASED E.S.R
• REDUCED QUADRICEPS ACTION
• PERSISTANT ANOREXIA
• HIGH SERUM CREATININE

6. • OFF LOADING OF
AFFECTED FOOT

7. WHAT CAUSES HIGH
PLANTAR PRESSURE?
• DISPLACEMENT OF
METATARSAL CUSHION
DISTALLY
• NON ENZYMATIC
GLYCOLISATION
• LIMITATION OF MOVEMENT OF
1ST MTP JOINT
• REDUCED ELASTICITY

8. WHAT CAUSES HIGH
PLANTAR PRESSURE?
• DECREASED SUBTALAR JOINT
MOVEMENT
• EXCESSIVE PLANTAR
KERATOSIS
• THICKENING OF SESMOID
• ADHESIONS & SCAR TISSUE

9. HOW DOES FOOT INJURY
OCCUR?
• PEAK PLANTAR PRESSURE:1340kPa
• SYSTOLIC BP 120 mm OF H:15 kPa
• CAPILLARY PRESSURE :6 kPa
• DELAYED/ABSENT RECOVERY FROM
ISCHAEMIA
• DELAYED/ABSENT RECOVERY OF
NORMAL TISSUE OXYGEN CONC.

10. HOW DOES FOOT INJRY
OCCUR?
• REPATATIVE MODERATE FORCE
• INFLAMMATION
• ERYTHEMA AND WARMTH
• COLLECTION OF EXUDATE
• BLISTER FORMATION
• BREAKDOWN OF SKIN --- ULCER

11. NEED FOR PROMPT
TREATMENT OF FOOT ULCER
• 85% OF DIABETIC FOOT
AMPUTATIONS ARE DUE TO
INADEQUATELY TREATED FOOT
ULCER
• 30-50% AMPUTEES REQUIRE
CONTRALATERAL AMPUTATION
IN 3 YEARS

12. NEED FOR PROMPT
TREATMENT IF FOOT ULCER
• 10% MORTALITY IN THREE YEARS IN
AMPUTEES
• ECONOMIC LOSS TO FAMILY AND
SOCIETY
• 22% REQUIRE IPSILATERAL HIGHER
AMPUTATION

13. FOOT ULCER ASSESSMENT
• PERIWOUND ERYTHEMA
• PERIWOUND ODEMA
• WOUND PURULENCE
• WOUND FIBRIN
• LIMB PITTING ODEMA
• LIMB BRAWNY ODEMA

14. FOOT ULCER ASSESSMENT
• WOUND GRANULATION
• VASCULAR STATUS
• WOUND MEASUREMENT
• OSTEOMYLITIS &
TENOSYNOVITIS

15. MECHANISM OF INJURY IN
DIABETIC FOOT
• NORMAL STRESS
• SHEAR STRESS
• FATIGUE
• STRESS CONCENTRATION
• ELATICITY

16. PRIMARY TREATMENT OF
DIABETIC FOOT ULCER
• EVALUATION
• METABOLIC CONTROL
• DEBRIDEMENT
• BACTERIAL CULTURE

17. PRIMARY TREATMENT OF
DIABETIC FOOT ULCER
• PARENTERAL ANTIBIOTICS
• OFF LOADING OF AFFECTED
FOOT
• REVASCULARIZATION
• CORRECT FOOTWEAR

18. OBJECTIVES OF DIABETIC
FOOT WEAR
• REDUCTION OF EXCESSIVE
PLANTAR PRESSURE
• REDUCTION OF SHOCK
• REDUCTION OF SHEAR
• ACCOMODATION OF DEFORMITY
• STABALIZATION OF DEFORMITY
• LIMITATION OF JOINT MOVEMENT

19. OBJECTIVES OF DIABETIC
FOOTWEAR
• WIDE TOEBOX
• EXTRA DEPTH
• SOFT UPPERS
• MCR/PLASTAZOAT INSOLE
• INSOLE WING PAD
• ORTHOWDGE CORRECTION
• WELL FITTING SOCKS

20. SURGERY FOR DIABETIC
FOOT ULCER
• PROPHYLACTIC
• THERAPEUTIC

21. PRPHYLACTIC SURGERY FOR
DIABETIC FOOT ULCER
• METATARSAL OSTEOTOMY
• METATARSAL HEAD RESECTION
• SESMOIDECTOMY
• DIGITAL ARTHROPLASTY
• BUNIONECTOMY
• LOCAL FLAPS