DIABETIC FOOT CAREHABIB BAKRI BIN MAMAT

60004049

HOSPITAL SULTANAH NUR ZAHIRAH (HSNZ)

EMERGENCY DEPARTMENT – DR. MOHD LOTFI HAMZAH (HOD OF ED HSNZ)ORTHOPAEDIC DEPARTMENT – DR. HJ. AHMAD TAJUDDIN B. ABDULLAH (SPINE SURGEON OF HSNZ)

MEDICAL ELECTIVES

OUTLINES▪ Backgrounds

▪ Approach to a Patient with Diabetic Foot Problems.

▪ Diagnosis and Identification of Risk Factors▪ Diabetic Foot Ulcers▪ Diabetic Foot Infections▪ Diabetic Charcot’s Foot

▪ TIME principle of wound bed preparation

▪ Prevention

▪ Conclusion

BACKGROUNDThe foot manifestation of diabetes is well documented and potentially limb threatening when left untreated.

A healthy, intact diabetic foot is best maintained by consistent and recurrent preventive treatment strategy.

Diabetes is chronic problem and the incidence of diabetic foot complications increases with age and duration of the disease.

Diabetic patients at risk for foot lesions must be educated about the risk factors and the important of foot care.

The primary management goal for diabetic foot is to heal the ulcer as early as possible and prevent amputation.

Resolving diabetic foot problems and decreasing the recurrence rate can lower the probability of lower extremity amputation.

APPROACH TO A PATIENT WITH DIABETIC FOOT PROBLEMS

Diagnosis & Evaluation

History - General Hx - Foot Specific Hx

- Wound Hx

Physical Examination A. General

B. Local – Musculoskeletal,

Dermatological, Vascular, Neurological, Footwear

Investigations - Lab

Ix, Imaging, Vascular Ix, Neurological Ix, Assessment

of plantar foot pressures

DIAGNOSIS AND IDENTIFICATION OF RISK FACTORS

▪Diabetic Foot Ulcer

▪Diabetic Foot Infections

▪Diabetic Charcot’s Foot

DIABETIC FOOT ULCER▪ Lower extremity assessment▪ Vascular▪ Neurological▪ Musculoskeletal

▪ Ulcer examination▪ Clinical▪ Search for osteomyelitis▪ Cultures & sensitivity▪ Radiographs

▪ Treatment▪ Debridement▪ Wound care▪ Off loading▪ Infection treatment▪ Vascular management▪ Medical Rx of comorbidities▪ Surgical management▪ Reduce risk of recurrence▪ Prevention

DIABETIC FOOT INFECTIONS▪ Assessment into ▪ Non- limb threatening ▪ Limb threatening

▪ Treatment▪ Surgical treatment▪ Wound care▪ Antibiotic treatment▪ Hyperglycemia control▪ Correct electrolytes▪ Optimize comorbidities▪ Frequent reassessment of

response to treatment▪ If infection subsides but ulcer

persists, follow principles of diabetic ulcer treatment

▪ Prevention

DIABETIC CHARCOT’S FOOT▪ Assessment▪ Clinical▪ Investigations▪ To exclude osteomyelitis

▪ Treatment ▪ Immobilization and rest ▪ Protected weight bearing ▪ Surgery ▪ Prevention

TIME PRINCIPLE OF WOUND BED PREPARATION

Tissue non viable or defecient

Infection or inflammation

Moisture imbalance

Edge of wound non advancing or undermined

Defective matrix and cell debris

High bacterial counts or prolonged inflammation

Desiccation or excess fluid

Non-migrating keratinocytesNon-responsive wound cells

Debridement Antimicrobials Dressings compression

Biological agentsAdjunct therapiesDebridement

Restore wound base and ECM protein

Low bacterial counts and control inflammation

Restore cell migration, maceration avoided

Stimulate keratinocyte migration

Viable/vascularize wound bed

Reduced inflammation

Optimal moisture balance

Epithelialized wound

PREVENTION▪ All efforts must be made to prevent foot complications from occurring

in diabetics and this is done through a multidisciplinary approach.

▪ Aspects of a diabetic foot prevention program include:▪ Education - patient (daily foot inspection) and physician (current

concepts of foot management) ▪ Foot care - Regular podiatric visits▪ Therapeutic Shoes - to protect from injury▪ Reduction of plantar pressure (off-loading) - to reduce plantar

pressure▪ Surgery - prevention of recurrent ulcers

CONCLUSION▪ Diabetes Mellitus is a lifelong disease and diabetic foot complications

can be life threatening, physically incapacitating, costly to treat and result in extensive morbidity.

▪ Screening, proper evaluation, early identification and treatment of the ‘at risk foot’ can reduce complications.

▪ A multidisciplinary team approach to diabetic foot problems can save costs and reduce most foot complications and amputation rate.

▪ If we manage diabetic foot problems according to this guidelines, we may attain the objectives of preventing limb loss, mortality maintain the quality of life of the patient.

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