Lecture on Diabetic Foot Complications

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 will understand 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 Ulcers
• One 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
amputation3,5
• ~85% of lower limb amputations in patients with
diabetes are preceded by ulceration6-7
• Peripheral neuropathy is a major contributing factor in
diabetic foot ulcers1-7
1. Reiber and Ledoux. In The Evidence Base for Diabetes Care. 4. Boulton et al. Lancet. 2005;366:1719.
Williams et al, eds. Hoboken, NJ: John Wiley & Sons; 5. Ramsey et al. Diabetes Care 1999;22:382.
2002:641–665. 6. Pecoraro et al. Diabetes Care. 1990;13:513.
2. Boulton et al. NEJM. 2004;351:48. 7. Apelqvist and Larsson. Diabetes Metab Res Rev.
3. Sanders. J Am Podiatry Med Assoc. 1994;84:322. 2000:16:S75.

5. Costs to Treat a 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 Rates
Armstrong 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 Advanced Treatments for
Wounds

9. Dermatological Considerations
• Dry Skin
• Fungal Infection
• Callus
• Interdigital lesions
• Ingrown Nail
• Ulceration

10. Dermatological Considerations
• Dry Skin
• Fungal Infection
• Callus
• Interdigital lesions
• Ingrown Nail
• Ulceration

11. Dermatological Considerations
• Dry Skin
• Fungal Infection
• Callus
• Interdigital lesions
• Ingrown Nail
• Ulceration

12. Dermatological Considerations
• Dry Skin
• Fungal Infection
• Callus
• Interdigital lesions
• Ingrown Nail
• Ulceration

13. Dermatological Considerations
• Dry Skin
• Fungal Infection
• Callus
• Interdigital lesions
• Ingrown Nail
• Ulceration

14. Dermatological Considerations
• Dry Skin
• Fungal Infection
• Callus
• Interdigital lesions
• Ingrown Nail
• Ulceration

15. Dermatological Considerations
• Dry Skin
• Fungal Infection
• Callus
• Interdigital lesions
• Ingrown Nail
• Ulceration

16. Dermatological Considerations
• Dry Skin
• Fungal Infection
• Callus
• Interdigital lesions
• Ingrown Nail
• Ulceration

17. Dermatological Considerations
• Dry Skin
• 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
• Callus
– Diabetic 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
• Callus
– Diabetic 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
• Callus
– Diabetic 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
• Callus
– Diabetic shoes
• Ulceration
– VAC
– Debridement
– Dermal Skin Substitute
– Platelet Rich Plasma

22. Dermatological Treatments
• Callus
– Diabetic shoes
• Ulceration
– VAC
– Debridement
– Dermal Skin Substitute
– Platelet Rich Plasma

23. Dermatological Treatments
• Callus
– Diabetic shoes
• Ulceration
– VAC
– Debridement
– Dermal Skin Substitute
– Platelet Rich Plasma

24. Nerve Considerations
• Neuropathy
• Semmes Weinstein 5.07
monofilament (10g)
• EMG and NCV

25. Nerve Treatments
• Neuropathy
– Medication Oral
– Topical Medication
– ENFB (Epidermal Nerve
Fiber Biopsy)

26. Musculoskeletal Considerations
• Foot Deformities
• Plantar Pressure
• Charcot Joint

27. Musculoskeletal Considerations
• Foot Deformities
• Plantar Pressure
• Charcot Joint

28. Musculoskeletal Considerations
• Foot Deformities
• Gait Evaluation
• Plantar Pressure
• Charcot Joint

29. Musculoskeletal Treatments
• Foot Deformities
– Preventative foot
surgery

30. Vascular Considerations
• Pulses
• Capillary filling time
• Color changes
• Edema
• Temperature

31. Vascular Considerations
• Pulses
– Revascularization
– Silverhawk
– Vascular flaps

32. Shoegear Considerations
• Type of shoe
• Fit
• Lining Wear
• Insoles, Orthoses
• Socks

33. Shoegear Modifications
• Diabetic extra-depth
shoes
• Diabetic socks
• Multi-density inserts

34. Thank You
Don Pelto, DPM
Central Massachusetts Podiatry, PC
Worcester, MA
508.757.4003
don@worcesterfootcare.com