diabetic foot problem

7/23/2019 Diabetic Foot Problem

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Workshop

Diabetic Foot Problems

Punto DewoDept. Of Ortho & Trauma

Medical Faculty Uniersitas !ad"ah Mada #

Dr. $ard"ito !eneral %ospital

o'yakarta( )* Oktober )+,-



Background

Prealence of diabetes mellitus • )./0 in )+++ to 1.10 in )+-+ ,

• increased from ,*, million to -22

million in )+-+,

• in 3ndonesia increased from /.1 millionin )+++ to ),.- million in )+-+ )

, Wild( $.( 4o'lic( !.( !reen( 5.( $icree( 4. & 6in'( %. !lobal prealence of diabetes estimates for theyear )+++ and pro"ections for )+-+. Diabetes Care 27( ,+1*78- 9)++1:.

) $utane'ara( D. & ;udhiarta( 5.5. The epidemiolo'y and mana'ement of diabetes mellitus in3ndonesia. Diabetes Res Clin Pract 8+ $uppl )( $<7$,2 9)+++:.



!lobal Problem

• Major amputation due todiabetes – worldwide problem – , ma"or amputation eery -+

seconds

•

Socially – =motional burden to patient

and family – 4eduction in >uality of life

• Mortality –

,+0 at or around time ofamputation – -+0 within , year – *+0 within 8 years

• Ma"or 5mputation leads to Loss

of Lif e 3nternational Diabetes Federation( 3nternational Workin'!roup on Diabetic Foot. ;akker et. al. )++8



D35;=T3? FOOT U@?=45T3OA 9DFU:

1. !" is still a c#ronic complication amongdiabetic patients wit# 1$ to 2% & 1

2. !" is t#e strongest predictor of lower

e'tremity amputations (L)*+ 1

, The 3nternational Bournal of @ower =Ctremity Wounds ,,9,: 8<21 E The 5uthor9s: )+,)



Modes of ?linicalPresentation

?ellulitis

Dry !an'rene ;i' Toe

Wet !an'rene

Dry !an'rene Forefoot

Ulcer Dorsum of Foot 3nfectie

5bscess Dorsum @eftFoot

Ulcers $ole of FootAeuropathic

?harcot Boint Disease Aecrotiin' Fasciitis



•

!eneral eCamination• @ocal eCamination 9Protect yourselfGG:

– 3nspect wound

–

Palpate wound – $mell wound

• 3nesti'ations

–@ab leucocyte count( %b5,c

– H74ay osteomyelitis( 'as( neuropathicchan'es



Osteomyelitis

?alciIcation of arteries



Mana'ement of Diabetic FootProblem

The foundation of treatment for diabetic foot ulcers9DFU: is based on the simple pneumonic( JK3Ps.L The JK3PsL stand for

Kascular 9ensurin' ade>uate limb perfusion:(

3nfection 9controllin' infection: and

Pressure 9miti'ation of plantar pressures throu'hproper ooadin':.


http://slidepdf.com/reader/full/diabetic-foot-problem 10/14,2%%-. *merican ollege of /#ysicians. *ll 0ig#ts 0esered.



D35;=T3? FOOT ?54= 5AD=DU?5T3OA

• ?%=?6 OU4 F==T=K=4 D5

• DO OU4 $== 4=D $POT$ N•

DO OU %5K= ?5@@U$=$ N



• T=$T T%= T=MP=45TU4= OF T%= W5T=4 ;=FO4= PUTT3A! OU4 F==T

• W5$% OU4 F==T W3T% @U6=W54M W5T=4 5AD M3@D $O5P

• 6==P $63A $UPP@= & MO3$TU43$=D

• ?UT OU4 A53@ ?O44=?T@ Do not cut the corner of your toe nails



Total contact cast The 'old standard for ooadin' therapy

ndication 3• Aon infected neuropathic foot ulcers without inolement of

deeper structures 9tendon( "oint capsule or eCposed bone:.

• Post7operatie care 9i.e charchot reconstruction:

• ?harchot neuroarthropathy

• Pre ulceratie conditions

ontraindication 3• Ulcers that hae si'ns of clinical infection

• Aeuropathic foot ulcers with inolement or eCposure of deeperstructures 9 tendon( "oint capsule( or bone:

• Ulcers that are deeper than they are in width.

• Patients with ascular status not ade>uate for healin'

• Patients with aller'ies to cast components



.

Total contact cast

diabetic foot problem

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