diabetic foot thongchai pratipanawatr md.. site of diabetic foot ulcers site% toe51 plantar...
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![Page 1: Diabetic foot Thongchai Pratipanawatr MD.. Site of Diabetic foot ulcers Site% Toe51 Plantar metatatarsal and mid foot 28 Dorsum of foot14 Multiple ulcers7](https://reader036.vdocument.in/reader036/viewer/2022081520/5697bfad1a28abf838c9bce1/html5/thumbnails/1.jpg)
Diabetic foot
Thongchai Pratipanawatr MD.
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Site of Diabetic foot ulcers
Site %
Toe 51
Plantar metatatarsal and mid foot
28
Dorsum of foot 14
Multiple ulcers 7
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Outcome of Diabetic foot ulcers
Outcome %
Reepithelization/primary healing
63
Amputation 24
Death 13
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Diabetic foot ulcer
Neuropathic foot ulcer
Ishemic foot ulcer
Mixed ishemic-neuropathic
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Neuropathic foot ulcer
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Risk factors of foot ulcers
Diabetic neuropathy increases risk of foot ulcer and amputation.
Neuropathy 1.7-folds
Deformity 12-folds
Previous history of ulcer
36-fold
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Distal sensory neuropathy
Loss pain, temperature And fine touch sensation burning sensation
Vibration, Position sense, Touch/pressure
Motor: intrinsic muscle
Small fiber
Large fiber
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Distal sensory neuropathy
Diagnosis10 gm monofilament: small fiber128 Hz tuning fork: large fiberMotor deformity: large fiber
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Sensory neuropathy
Loss of protective sensation5.07 (10 gram) Monofilament
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Area of examination
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Deformity
Abnormal Foot pressure
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Deformity
Claw toesClaw toes
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Neuropathic foot ulcer
Loss of sensationDeformityCallous formationCallous ruptureFoot ulcerInfection
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Diabetic foot ulcer
Insensitive footInappropriate shoe (too tight)DeformityIschemic foot ulcer
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Insensitive foot
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Insensitive foot
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Insensitive foot examination
Examination Justification
General Inspect for possible ulceration
Sensory Test sensation
Temperature Local temp increase more than 2 C indicates of infection
Shoes Inspect foot ware
Muscle Muscle deformaty
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Neuropathic foot ulcer
Loss of sensationDeformityCallous formationCallous ruptureFoot ulcerInfection
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Claw toes
DeformityDeformity
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Hammer toes
DeformityDeformity
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CallousCallous
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UlcerUlcer
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Chronic ulcer with osteomyelitis
OsteolyticOsteolyticbonebone
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Charcot’s foot
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Charcot’s foot
Acute Charcot’s foot
Chronic Charcot’s foot
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Charcot’s foot
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Chacort’s deformity
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Others neuropathic ulcer
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Too tight shoe
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Too tight shoe
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Too tight shoe
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Too tight shoe
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Too tight shoe
![Page 34: Diabetic foot Thongchai Pratipanawatr MD.. Site of Diabetic foot ulcers Site% Toe51 Plantar metatatarsal and mid foot 28 Dorsum of foot14 Multiple ulcers7](https://reader036.vdocument.in/reader036/viewer/2022081520/5697bfad1a28abf838c9bce1/html5/thumbnails/34.jpg)
Too tight shoe
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Ishemic foot ulcer
![Page 36: Diabetic foot Thongchai Pratipanawatr MD.. Site of Diabetic foot ulcers Site% Toe51 Plantar metatatarsal and mid foot 28 Dorsum of foot14 Multiple ulcers7](https://reader036.vdocument.in/reader036/viewer/2022081520/5697bfad1a28abf838c9bce1/html5/thumbnails/36.jpg)
Ischemic foot ulcer
![Page 37: Diabetic foot Thongchai Pratipanawatr MD.. Site of Diabetic foot ulcers Site% Toe51 Plantar metatatarsal and mid foot 28 Dorsum of foot14 Multiple ulcers7](https://reader036.vdocument.in/reader036/viewer/2022081520/5697bfad1a28abf838c9bce1/html5/thumbnails/37.jpg)
Ischemic foot ulcer
![Page 38: Diabetic foot Thongchai Pratipanawatr MD.. Site of Diabetic foot ulcers Site% Toe51 Plantar metatatarsal and mid foot 28 Dorsum of foot14 Multiple ulcers7](https://reader036.vdocument.in/reader036/viewer/2022081520/5697bfad1a28abf838c9bce1/html5/thumbnails/38.jpg)
Ischemic foot ulcer
![Page 39: Diabetic foot Thongchai Pratipanawatr MD.. Site of Diabetic foot ulcers Site% Toe51 Plantar metatatarsal and mid foot 28 Dorsum of foot14 Multiple ulcers7](https://reader036.vdocument.in/reader036/viewer/2022081520/5697bfad1a28abf838c9bce1/html5/thumbnails/39.jpg)
Diabetic foot care
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Risk factors of foot ulcers
Diabetic neuropathy increases risk of foot ulcer and amputation.
Neuropathy 1.7-folds
Deformity 12-folds
Previous history of ulcer
36-fold
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Management category
Risk Sensation Deformity Hx of ulcer
0 Present No No
1 absent No No
2 absent Yes No
3 absent Yes Yes
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Management category
Risk Managment
0 Foot clinic one a year; foot education
1 Foot clinic every 6 months, appropriated footwear and soft insole
2 Foot clinic every 3 months, custom-molded orthotic devices
3 Foot clinic every 1-2 months, custom-molded orthotic devices
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Foot education
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Daily cleaning
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Skin & nail care
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ผิ�วแห้�งผิ�วแห้�ง-- แตกแตก
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Appropriated footwear and soft insole
![Page 48: Diabetic foot Thongchai Pratipanawatr MD.. Site of Diabetic foot ulcers Site% Toe51 Plantar metatatarsal and mid foot 28 Dorsum of foot14 Multiple ulcers7](https://reader036.vdocument.in/reader036/viewer/2022081520/5697bfad1a28abf838c9bce1/html5/thumbnails/48.jpg)
Proper shoes design
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Proper shoes &soft insole
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เลื อกรองเท้�าท้��เห้มาะสมก�บเท้�า เลื อกรองเท้�าท้��เห้มาะสมก�บเท้�า ไม�คั�บห้ร อห้ลืวมจนเก�นไปไม�คั�บห้ร อห้ลืวมจนเก�นไป
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รองเท้�าท้��ไม�เห้มาะสมก�บเท้�า รองเท้�าท้��ไม�เห้มาะสมก�บเท้�า
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Custom-molded orthotic devices
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Soft inserts
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Mold insoles
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Total contact insole
![Page 56: Diabetic foot Thongchai Pratipanawatr MD.. Site of Diabetic foot ulcers Site% Toe51 Plantar metatatarsal and mid foot 28 Dorsum of foot14 Multiple ulcers7](https://reader036.vdocument.in/reader036/viewer/2022081520/5697bfad1a28abf838c9bce1/html5/thumbnails/56.jpg)
Foot wear
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CallousCallous
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CallousCallous
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Diabetic wound care
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Depth-ischemia classification
Grade Definition
0 At risk (previous ulcer or neuropathy with deformity
1 Superficial ulcer, no infection
2 Deep ulceration exposing tendon or joint (with or without infection)
3 Extensive ulceration with expose bone or deep infections
Depth classification
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Depth-ischemia classification
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Depth-ischemia classification
Grade Definition
A Not ischemia
B Ischemia without gangrene
C Partial (forefoot) gangrene of the foot
D Complete foot gangrene
Ischemia classification
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Depth-ischemia classification
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Depth-ischemia classification
Grade Definition
0 At risk (previous ulcer or neuropathy with deformity
1 Superficial ulcer, no infection
2 Deep ulceration exposing tendon or joint (with or without infection)
3 Extensive ulceration with expose bone or deep infections
Depth classification
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Depth-ischemia classification
Grade Intervension
0 Patient education and appropriated foot ware
1 External pressure relief
2 And surgical debridement (antibiotic)
3 And antibiotic; amputaiton may be
Depth classification
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Off-loading
Total contact cast (TCC) -gold standardPrefabricated pneumatic walking brace ( Air
cast )Half-shoesCrutches,Walkers and WheelchairsBed rest
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Total contact cast
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Air cast
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Half shoe
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Modified/custom shoes/orthoses
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Surgical intervenion
DebridementAmputationOsteotomyBone stabilizationTendon tranfer or Tenotomy Achilles tendon lengthening tendonetc.
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Depth-ischemia classification
Grade Definition
A Not ischemia
B Ischemia without gangrene
C Partial (forefoot) gangrene of the foot
D Complete foot gangrene
Ischemia classification
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Vascular screening♦ Hair loss♦ Color♦ Baked potato skin♦ Capillary filling time♦ Temperature♦ Pulses♦ Ankle brachial index (ABI)
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Thank you