the diabetic foot: an overview - diabetic foot mansoura … · the diabetic foot: an overview...
TRANSCRIPT
![Page 1: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/1.jpg)
The Diabetic foot: An ioverview
Mamdouh Radwan El-NahasProfessor of Internal Medicine
Diabetes and Endocrinology unitMansoura University
![Page 2: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/2.jpg)
It will be a tragedy if we restrict the termIt will be a tragedy if we restrict the term DF to advanced stages of the disease
![Page 3: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/3.jpg)
The aims of any diabetic foot servicefshould be preservation of the limb.
If the amputation become the onlyoption, this indicate failure of DFservices.Many studies considered amputationrate to reflect the efficacy of foot carerate to reflect the efficacy of foot careservices in a country.
![Page 4: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/4.jpg)
What is meant by diabetic f ?foot?
![Page 5: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/5.jpg)
The WHO definition of theThe WHO definition of the diabetic foot
The foot of a diabetic patient that hasfthe potential risk of pathologic
consequences including infection,l i d d i f dulceration and or destruction of deep
tissues associated with neurologicb li i i d fabnormalities, various degrees of
peripheral vascular disease and/orb li li i f di b imetabolic complications of diabetes in
the lower limb
![Page 6: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/6.jpg)
Any foot pathology that resultsdirectly from diabetes or its long-term complications (Boultonterm complications (Boulton2002).
Diabetes, 30 : 36, 2002.
![Page 7: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/7.jpg)
History of the diabetic footfoot
![Page 8: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/8.jpg)
Ancient Egyptianth i f thprosthesis of the
big toe
Lancet 2000; 356:2176–792176 79
![Page 9: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/9.jpg)
The suggestion that peripheral nerve dysfunction could lead to diabetic foot ulceration
Pryce reported a case of perforating ulcers of both feet associated with diabetes and ataxicboth feet associated with diabetes and ataxic symptoms. Lancet 2:11–12,1887.
![Page 10: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/10.jpg)
Only in the last 20 years progressin the understanding of thepathogenesis and management ofpathogenesis and management ofthe diabetic foot had been made.
![Page 11: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/11.jpg)
Foot council have been formed by international diabetesby international diabetes
associations
In 1987: the ADA formed footilcouncil
In 1998: the EASD formed thedi b ti f t t ddiabetic foot study group
![Page 12: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/12.jpg)
However
There is still a gap between what isknown about Diabetic foot andwhat is really done to the feet ofwhat is really done to the feet ofthe diabetic patients.
![Page 13: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/13.jpg)
IWGDF
In 1996 a group of experts in the fieldof the diabetic foot expressed theneed for an international set ofneed for an international set ofdefinitions and guidelines onprevention and management of theprevention and management of thediabetic foot (International working
th di b ti f t)group on the diabetic foot)
![Page 14: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/14.jpg)
Launching of theInternational ConsensusInternational Consensusdocument and PracticalGuidelines on theGuidelines on theManagement and Preventionof the Diabetic Foot wasdone in 1999.3 supplements in 2003 oni f i l ifi i dinfection, classification andwound healing.
![Page 15: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/15.jpg)
![Page 16: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/16.jpg)
IWGDF search for representativeallover the world to convey theirmessages in different countriesmessages in different countries
![Page 17: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/17.jpg)
h d h fWe are honored that one of ourteam: Professor Hanan Gawishbecome Egypt Representative ofthe IWGDF.the IWGDF.
![Page 18: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/18.jpg)
The Arabictranslation of theInternationalConsensus on theManagement of theDiabetic Foot isnow available
![Page 19: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/19.jpg)
The natural history of the ydiabetic foot
![Page 20: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/20.jpg)
It is unwise to consider thatmajor diabetic foot problemsoccur all of the suddenoccur all of the sudden.
![Page 21: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/21.jpg)
The natural history of the ydiabetic foot (Edmonds 2006)
Stage 1: A normal footStage 1: A normal footStage 2: A high risk footStage 3: An ulcerated footStage 4: An infected footStage 4: An infected footStage 5: A necrotic foot.
![Page 22: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/22.jpg)
Stage 1: A normal footStage 1: A normal footStage 2: A high risk footStage 3: An ulcerated footStage 4: An infected footStage 4: An infected footStage 5: A necrotic foot.
![Page 23: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/23.jpg)
Types of DFU
![Page 24: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/24.jpg)
DFU is a pivotal event in diabetic pfoot syndrome
DFUDFU RF amputation
![Page 25: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/25.jpg)
Detection of high risk foot should beDetection of high risk foot should be first priority in any DF service
S l fStage 1: A normal footStage 2: A high risk footStage 2: A high risk footStage 3: An ulcerated footStage 4: An infected footStage 5: A necrotic footStage 5: A necrotic foot.
![Page 26: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/26.jpg)
What are the risk factors for DFUfor DFU
![Page 27: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/27.jpg)
P i h l thPeripheral neuropathyBiomechanical dysfunction (Deformities, High
l t Li it d j i t bilit )plantar pressures, Limited joint mobility)Peripheral vascular diseasePrevious UlcerTrauma ( e.g. inappropriate foot wear)
![Page 28: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/28.jpg)
Long duration of diabetes and Elevated HbA1HbA1c. Diabetic nephropathy and retinopathyObesityDiabetic patients with foot ulcerations appear
“to be more non-compliant. A syndrome of “willful self-neglect” has been described in patients ith diabetes and foot lcerspatients with diabetes and foot ulcers.Male gender?
![Page 29: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/29.jpg)
A critical triad!The critical triad of:
1) Neuropathy1) Neuropathy2) Trauma
F t d f it3) Foot deformity
is present in the majority of ulcerated patients.
![Page 30: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/30.jpg)
Paul Brand (1914–2003) was asked onUS Department of Health conference toUS Department of Health conference tomake a recommendation on reducingamputation in diabetesMost listeners expected an answer
promoting advanced technology.h i d h h hi kThey were surprised to hear that his key
recommendation was a nationalcampaign to encourage physicians tocampaign to encourage physicians toremove patients shoes and socks and toexamine the feet
![Page 31: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/31.jpg)
The high risk foot
The high risk foot is the foot that has f fdeveloped one or more of the following
risk factors for ulceration: NeuropathyIschaemiaIschaemia
DeformitySwellingSwelling
Callus.
![Page 32: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/32.jpg)
There is no what is called trivial lesiontrivial lesion
![Page 33: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/33.jpg)
The callus
5 percent of the United Statespopulation have corns or calluses.In diabetic patients dry skin in which evenslight pressure and friction is sufficient to causeexcessive callus formation.82 % of diabetic foot ulceration werepreceded by a focal pressure keratosispreceded by a focal pressure keratosis(Sage et al 2001).
![Page 34: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/34.jpg)
Are DFU risk factors a common problem that deserve screeningproblem that deserve screening
![Page 35: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/35.jpg)
5%20%
No abnormality
20% 55%
Increased risk
High Risk
DFU CLI Gangrene 20% 55%DFU, CLI, Gangrene
![Page 36: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/36.jpg)
Are these figures fixed allover the world?
![Page 37: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/37.jpg)
Altho gh the path a s toAlthough the pathways toulceration and amputation do notdiffer.
There is racial differences in thel f DFU & h i i kprevalence of DFU & their risk
factors and amputation.p
![Page 38: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/38.jpg)
Racial differences
i b i f d lDiabetic foot syndrome was lesscommon in Asia with contradictoryyresults in Africa.
![Page 39: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/39.jpg)
El-Nahas M, Gawish H, Tarshoby M and State O: The, , yprevalence of foot ulcer risk factors in Egyptian diabeticpatients. Diabetologia. 49: (Suppl 1): 682, 2006
![Page 40: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/40.jpg)
How can we classify our patients into different risk groupsinto different risk groups
![Page 41: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/41.jpg)
The IWGDF had proposed a classification system.classification system.
![Page 42: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/42.jpg)
Check upRisk profilecategory Check up frequency
Risk profilecategory
Once a yearNo sensory ne opath
0neuropathy
Once every 6Sensory1 Once every 6month
Sensory neuropathy(DN)
1
Once every 3 month
DN and PAD and/or foot deformities
2monthfoot deformities
Once every 1-Previous ulcer3 Once every 13 month
Previous ulcer3
![Page 43: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/43.jpg)
Conclusion
The diabetic foot service should beavailable for all diabetic patients.available for all diabetic patients.
![Page 44: The Diabetic foot: An overview - Diabetic Foot Mansoura … · The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit](https://reader030.vdocument.in/reader030/viewer/2022013014/5b1cebda7f8b9aad5d8ba671/html5/thumbnails/44.jpg)
Conclusion
The e is a lot of signs that p ecedeThere is a lot of signs that precedemajor events.
The earlier you will detect andThe earlier you will detect andmange your patient the better willb h ibe the prognosis.