1 / 21

DIBETIC FOOT ULCER

DIBETIC FOOT ULCER. ETIO-PATHOGENESIS & MANAGEMENT DR.ARUN BAL S.L.RAHEJA HOSPITAL. METHOD OF OFF-LOADING. BEDREST CRUCTHES WHEELCHAIR SPECIAL FOOTWEAR CONTACT CASTING. MECHANISM OF INJURY. DIRECT PENETRATION OF SKIN SMALL AMOUNT OF FORCE SUSTAINED OVER A PERIOD OF TIME

gala
Download Presentation

DIBETIC FOOT ULCER

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related