Diabetic Foot Globally

DR JAYESH KAKARDR JAYESH KAKARDR JAYESH KAKARDR JAYESH KAKARConsultant Diabetic Foot & Peripheral Vascular Surgeon

SAVE LEGS CLINICSAVE LEGS CLINICTEL : 9966668283TEL : 9966668283

www.savelegs.com

Hon Consultant : HyderabadHon Consultant : Mumbai Hon Consultant : Hyderabad Global Hospitals, Mahavir Hospital

Hon Consultant : MumbaiBreach Candy Hospital

BSES MG Hospital

WHY THE NAME ?

SAVELEGS.COMSAVELEGS.COM

AIMS :

After a thorough Clinical, Radiological & Orthotic Evaluation of patients, we aim to achieve the BEST in

•LEG CONSERVATION

•AMPUTATION PREVENTION

•REHABILITATION OF PATIENTS


THE CLINIC IS DEDICATED TO THE PREVENTION & TREATMENT OF

LOWER LIMB DISORDERSLOWER LIMB DISORDERS

TREATMENT

INVESTIGATIONS

PREVENTIVE CARE & REHABILITATIONPREVENTIVE CARE & REHABILITATION

FOOT AIDS like CUSTOMIZED FOOTWEAR, MEDICAL COMPRESSION STOCKINGS INSOLES and otherCOMPRESSION STOCKINGS, INSOLES, and other PODIATRIC AIDS

Are available for the FIRST time under one ROOF, for ,MAXIMUM CARE & CONVENIENCE OF PATIENTS.


EVEN THOUGH WE TREAT MOST FOOT & LEG PROBLEMS

THE FOCUS OF THIS PRESENTATION WILL BE ON SOME OF THE COMMONEST PROBLEMS

PICTORIALS, GRAPHICS & TEXT

AIM IS TO SPREAD AWARENESS - WITH THE SCIENCE OF LEG SALVAGE & PODIATRY, IT IS TODAY POSSIBLE TO SAVE LIMBS & CURE LEG PROBLEMS THAT A FEWTO SAVE LIMBS & CURE LEG PROBLEMS THAT A FEW YEARS BACK WERE CONSIDERED EITHER CHRONIC OR INCURABLE


PODIATRY ( TREATMENT OF FOOT DISORDERS ))

SURGICALLY : FOOT MODIFICATIONSURGICALLY : FOOT MODIFICATION

USE OF ORTHOTICSUSE OF ORTHOTICS


ORTHOTICS

THE USE OF SPECIFIC DEVICES, CUSTOM MADE TO

TREAT/PREVENT VARIOUS PROBLEMS ATTRIBUTABLE TO

THE FOOTTHE FOOT.


C L & F t P blCommon Leg & Foot Problems


DIABETES STATISTICS

•6% of Global Mortality

•Every 10 Seconds a person dies of Diabetes Related Mortality

•Every 10 Seconds 2 People develop Diabetesy p p

•Upto 25% of Family Income may go towards Diabetes care in Low Income Indian Families

•India has the World’s LARGEST Diabetes population

•40 % of admissions of Diabetic Patients are due to FOOT40 % of admissions of Diabetic Patients are due to FOOTProblems


Diabetic foot

15% of diabetics experience serious foot pproblems.They are the leading cause of hospitalizations y g pfor these patients.

DIABETES IS THE LEADING CAUSE OFNON TRAUMATIC LOWER LIMB AMPUTATIONS – 50-70%


2006 FIGURES2006 FIGURES


DIABETIC FOOT

THIS TERM WOULD NORMALLY EVOKE ONE OF THE FOLLOWING PICTURES :FOLLOWING PICTURES :

LEADING TO THISTO THIS


IGNORANCE IS BLISSIGNORANCE IS BLISS


Diabetes & Foot Check UpDiabetes & Foot Check Up

NEUROTHESIOMETER C W DOPPLER To MeasureNEUROTHESIOMETER To Detect Nerve Damage

C-W DOPPLER To Measure Blood Supply to the Feet

DIABETICS MUST GET THEIR FEET CHECKED ONCE AN YEAR TO AVOID FOOT COMPLICATIONS

SAVELEGS.COMSAVELEGS.COM*Report of the The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997;20(7):1183-1197.

DIAGNOSISDIAGNOSIS

•BURNING/TENDERNESS/NUMBNESS IN THE FEET

•LOSS OF BALANCE

•SHARP PAINS OR CRAMPS

•FEELING OF ‘SOMETHING’ UNDER THE FOOT

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COMMON FOOT PROBLEMS IN DIABETICS

•Infection •Pus formation•Ulcerations•Gangrenei h f fin the feet of long standing diabetics.

Ulcer- Common SIGHT & Site in Diabetic Patients


GangreneGangrene

Toe Gangrene Heel Gangrene


Varicose VeinsTender soft knots or winding veins in the calf

or leg that are worse after standing for long

periodsperiods.

May also present as aching

& swollen legs at the end

of the day.


TREATMENT

SURGERYSURGERYSURGERYSURGERYMOST PATIENTS WITHOUT COMPLICATIONS CANMOST PATIENTS WITHOUT COMPLICATIONS CAN BE MANAGED AS DAYCARE OR SHORT TERM(1-2 DAYS) STAY CASESDAYS) STAY CASES

LASER TREATMENT


Chronic Venous InsufficiencyECZEMA AND SKIN CHANGESECZEMA AND SKIN CHANGESA form of eczema can occur in the calf, sometimes over an area of varicosity. The skin is red and itchy.over an area of varicosity. The skin is red and itchy. Areas of the calf and around the ankle may develop a brown stain in the skin. b ow sta t e s .


WHO GETS VENOUS PROBLEMS ?

1. HEREDITARY – 50%2. PEOPLE STANDING/SITTING AT WORK FOR LONG

PERIODS e.g. TEACHERS, NURSES, POLICEMEN, BUSPERIODS e.g. TEACHERS, NURSES, POLICEMEN, BUS CONDUCTORS etc.

WHAT WORSENS IT ?

1. SMOKING2. OVERWEIGHT


COMMON SYMPTOMS OF VENOUS

1 H i t i i th l

PROBLEMS1.Heaviness or tension in the legs.

2.Swelling or Feeling of swelling ALL SYMPTOMS TEND

in the legs- especially around the

ankles.

TO INCREASE IN THE EVENINGS OR AFTER STANDING FOR LONG PERIODS AND

3.Itching or tingling.

4.Burning Sensation in the legs.

PERIODS AND DECREASE WITH LEG ELEVATION

4.Burning Sensation in the legs.

5.Cramps.

6 Restless/Tired legs6.Restless/Tired legs


COMPLICATIONS OF VENOUS DISORDERS

•HAEMORRHAGE (Bleeding)

•THROMBOPHLEBITIS


SKIN CHANGES : - Darkening of the Skin due to S C G S gPIGMENTATION

•VENOUS ULCERSVENOUS ULCERS


Peripheral Vascular Disease Arterial ProblemsP i i th lPain in the legs on

walking (relieved by g ( y

rest)


NON HEALING ULCERS IN THE LEG AND FEETNON HEALING ULCERS IN THE LEG AND FEET

More common in diabetics, smokers, the obese or people with a family history of atherosclerotic disease.p p y y


Heel SpurPresents as a sharp pain in the centre of the heel worse in the morning and begins toheel, worse in the morning and begins to lessen as you begin to walk.


INGROWN TOE NAIL

A toenail which appears to beA toenail, which appears to be abnormally shaped and repeatedly keeps getting i f t d d di h iinfected and discharging pus or a watery discharge tinged with blood.

CORNS & CALLOSITIESCORNS & CALLOSITIESThickened and painful areas of skin.


FOOT DEFORMITIES


DEFORMED FOOT DUE TO DIABETES

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BUNION Outward deviation Of the Great Toe

HAMMER TOES

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BUNIONS &BUNIONS & ULCERS > 5YRS IN A DIABETIC

4 MONTHS AFTER SURGERYSURGERY

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FOOT ULCER 20 YRS DURATION

3 MONTHS AFTER TREATMENTTREATMENT

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HEEL ULCER WITHHEEL ULCER WITH PVD WITH DIABETES > 6-7 YRS

4 MONTHS AFTER SURGERY & WOUND CARE

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CVI WITH CELLULITIS WITH ULCERATION

5 MONTHS AFTER SURGERYSURGERY

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LARGE VENOUS ULCER > 5 YRS 4 MONTHS AFTER SURGERY

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MANAGEMENTMANAGEMENT

• CUSTOMIZED FOOTAIDS (ORTHOTICS)• CUSTOMIZED FOOTAIDS (ORTHOTICS)

• FOOT MODIFICATION TO PREVENT C C A ORECURRENT ULCERATION


Ischemic ulcerationIschemic ulceration

Hair loss

P ll /C i /R bPallor/Cyanosis/Rubor

Muscle atrophyp y

Smooth, shiny skin, ed skin t ttemperature

Edema


VASCULAR BYPASS VASCULAR BYPASS SURGERYSURGERY


OTHER MODALITIES

HBO

PROSTAGLANDINS

MAGGOT THERAPY

HONEYHONEY

ULTRASOUND ETC

HAVE NO WELL DEFINED ROLE BUT MAY BE USED INHAVE NO WELL DEFINED ROLE BUT MAY BE USED IN SELECTED/RESISTANT CASES AT THE DISCRETION OF THE TREATING PHYSICIAN


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Diabetic Foot Globally

Health & Medicine

Transcript of Diabetic Foot Globally