Diabetic Foot An Overview

2. Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal Tarshoby. Dr.Omnia State. Diabetic Foot An Overview Foot team • Prof.Mamdouh El Nahas • Prof.Hanan Gawish • Dr. Manal Tarshoby • Dr.Omnia State

3. World Diabetes Day 2005 Diabetes and Foot Care Put Feet First Prevent Amputations

4. 2005: a Year-long Campaign

5. Campaign Objectives • Inform people of the extent of diabetic foot problems worldwide. • Persuade people that action is both possible and affordable. • Warn people of the consequences of not taking action.

6. FOOT FACTS(1) • Every 30 seconds a leg is lost to diabetes somewhere in the world. • Up to 70% of all leg amputations happen to people with diabetes. • DF problems are the commonest cause of hospital admission. (by us?)

7. FOOT FACTS(2) • Most amputations begin with a foot ulcer. • One in every six people with diabetes will have a foot ulcer during their lifetime. • Good News Up to 85% of amputations can be avoided.

8. Egypt Representative Mansoura University Prof.Mamdouh El Nahas. Dr.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia Stat

9. Levels of foot management • Level 1 General practitioner, diabetic nurse and podiatrist • Level 2 Diabetologist, surgeon (general and/or vascular and/or orthopedic), diabetic nurse and podiatrist • Level 3 Specialized foot center

10. Value of Podiatric Care • KINGS COLLEGE HOSPITAL. • 1984 establishment of • DIABETIC FOOT CLINIC. • Amputation decreased 50% in • 3 years.

11. Diabetic Foot

12. Diabetic Foot Disease • Ischaemia • Neuropathy • Infection • Structural deformity • Ulcer • Amputation

13. Regular inspection and examination of the foot.Identification of the foot at risk.Education of patient, family and healthcare providers.Appropriate footwear.Treatment of non ulcerative pathology Five cornerstones of the management of the diabetic foot

14. Regular inspection and examination of the foot.Identification of the foot at risk.Education of patient, family and healthcare providers.Appropriate footwear.Treatment of non ulcerative pathology Five cornerstones of the management of the diabetic foot

15. Regular inspection and examination of the foot • All diabetic patients should be examined at first presentation then at least once a year • Patients with risk factors should be examined every 1-6 months • Absent symptoms does not mean that the feet are healthy • Examine the patient on lying down and standing up • Shoe and socks should be inspected

16. History • Previous ulcer , amputation • Previous foot education • Bare-foot walking • Poor access to healthcare • Smokimg , alcohol • Nephropathy,Retinopathy • Hypertension • Ischemic heart disease

17. Foot examination • Nails Thick too long ingrown fungal infection wrongly cut nails

18. Foot Examination • Foot deformity:

19. Foot Examination • Foot deformity: Toe deformity • Hammer toe • Claw toe

20. Toe Deformity:– Hammer Toe • Increased pressure on 2ndmetatarsal head • Increased pressure on prox. IPJ • Increased pressure on distal IPJ • Increased pressure on apex • Increased pressure on nail fold

21. Foot Examination • Foot deformity: Toe deformity Forefoot deformity • Hallux valgus • Hallux rigidus

22. Hallux Valgus

23. Hallux Rigidus Osteoarthritic Degeneration 1st MTP Joint Limitation of Dorsiflexion Overloading 2nd MTP Joint / 1st IPJoint

24. Foot Examination • Foot deformity: Toe deformity Forefoot deformity Wholefoot Deformities • Pes Cavus - High arched foot • Pes Planus - Flat foot • Charcot foot

25. Diagnosis of Acute Charcot • Painless • Redness, swelling, and more than 2°C skin temperature difference when compared with the contralateral foot. • Dorsalis pedis pulses are often bounding. • The patient is afebrile unless a systemic infection is present.

27. Foot Examination • Foot deformity: Toe deformity Forefoot deformity Whole foot Deformities Prominent metatarsal heads

28. Foot Examination • Skin condition: Callus Bunions Redness Warmth Fissure Dryness Swelling Maceration Fungal infection

29. Callus • Presence of callus is a significant marker for the development of foot ulceration • The hyperkeratosis is a result of hypertrophy under the influence of intermittent compression . • the callus is either a reaction to abnormal pressure or an abnormality of the area to handle normal pressure.

30. Tenia Pedis

31. Foot Examination • Vascular assessment: History Intermitent claudication Rest pain Colour of the skin Temperature gradient

32. Foot Examination • Vascular assessment: Pedal pulse Dorsalis pedis Posterior tibial

33. Foot Examination • Vascular assessment: Pedal pulse Dorsalis pedis Posterior tibial Ankle Brachial Pressure Index

34. Tempreature • Vibration Sense • Touch and Pressure • Light Touch • Proprioception (Romberg’s Sign) • Superficial Pain • Reflexes Foot Examination • Neurological assessment:

35. Neurologic assessment • Temperature • Vibration Sense • Pressure Sense • Light Touch • Proprioception • Reflexes

36. Neurologic assessment

37. Neurologic assessment • Temperature • Vibration Sense • Pressure Sense • Light Touch • Proprioception (Romberg’s Sign) • Superficial Pain • Reflexes

38. TEMPERATURE TESTING • Two test tubes, hot/cold. • Therm-tip • Subjective, crude tests

39. Neurologic assessment • Temperature • Vibration Sense • Pressure Sense • Light Touch • Proprioception • Superficial Pain • Reflexes

40. VIBRATION SENSE

41. NEUROTHESIOMETER

42. Neurologic assessment • Temperature • Vibration Sense • Pressure Sense • Light Touch • Proprioception • Superficial Pain • Reflexes

43. MONOFILAMENTS • 10 gm • Sites tested • Technique • Significance

45. Neurologic assessment • Temeprature • Vibration Sense • PressureSense • Light Touch • Proprioception • Superficial Pain • Reflexes

46. LIGHT TOUCH TEST

47. Neurologic assessment • Temperature • Vibration Sense • Pressure Sense • Light Touch • Proprioception • Superficial Pain • Reflexes

48. PROPRIOCEPTION TEST • Tested by dorsiflexing and plantarflexing the hallux. Can the patient determine the position of the hallux?

49. Neurologic assessment • Temperature • Vibration Sense • Pressure Sense • Light Touch • Proprioception • Superficial Pain • Reflexes

50. SUPERFICIAL PAIN TEST