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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 )+,-
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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)+++:.
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!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
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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: )+,)
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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
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•
!eneral eCamination• @ocal eCamination 9Protect yourselfGG:
– 3nspect wound
–
Palpate wound – $mell wound
• 3nesti'ations
–@ab leucocyte count( %b5,c
– H74ay osteomyelitis( 'as( neuropathicchan'es
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Osteomyelitis
?alciIcation of arteries
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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':.
7/23/2019 Diabetic Foot Problem
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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
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• 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
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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
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.
Total contact cast