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Diabetic Foot PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Diabetic Foot” by Dr. Amit Gupta.

This medical PowerPoint presentation is about diabetic foot, a complication of diabetes that affects the feet. It is caused by prolonged periods of high blood sugar levels, which can damage the nerves and blood vessels in the feet. This can lead to a loss of sensation in the feet, making it difficult to detect injuries or infections. If left untreated, diabetic foot can lead to serious complications, including amputation.

Tags : diabetic foot, high blood sugar levels, Orthopaedic Surgery, Orthopaedic Surgery PowerPoint presentation

Published on : Jun 23, 2023 | Views : 2014 | Downloads : 9

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Slide 1-

Diabetic Foot Dr. Amit Gupta Associate Professor Dept of Surgery
Slide 2-

Objectives Define diabetic foot Explain etiopathogenesis of diabetic foot ulcer Wagner grades Understand Charcot’s foot Explain prevention strategies to patient
Slide 3-

Definition A foot with a constellation of pathologic changes affecting the lower extremity in diabetics, often leading to amputation and/or death due to complications; the common initial lesion leading to amputation is a nonhealing skin ulcer, induced by regional pressure, pathogenically linked to sensory neuropathy, ischemia, infection -
Slide 4-

Extent 20 million DM patients in India ( 2 Crore) DM largest cause of neuropathy Half don’t know Foot ulcerations is most common cause of hospital admissions for Diabetics Expensive to treat, may lead to amputation and need for chronic institutionalized care
Slide 5-

After amputation 30% lose other limb in 3 years After amputation 2/3rds die in five years Type II can be worse 15% of diabetic will develop a foot ulcer
Slide 6-

Pathophysiology Vascular disease Neuropathy Sensory Motor Autonomic
Slide 7-

Neuropathy Changes in the vasonervosum with resulting ischemia ? cause Increased sorbitol in feeding vessels block flow and causes nerve ischemia Intraneural accumulation of advanced products of glycosylation Abnormalities of all three neurologic systems contribute to ulceration
Slide 8-

Vascular Disease 30 times more prevalent in diabetics Diabetics get arthrosclerosis obliterans or “lead pipe arteries” Calcification of the tunica media Endothelial changes Often increased blood flow with lack of elastic properties of the arterioles Not considered to be a primary cause of foot ulcers
Slide 9-

Autonomic Neuropathy Regulates sweating and perfusion to the limb Loss of autonomic control inhibits thermoregulatory function and sweating Result is dry, scaly and stiff skin that is prone to cracking and allows a portal of entry for bacteria
Slide 10-

Autonomic Neuropathy
Slide 11-

Motor Neuropathy Mostly affects forefoot ulceration Intrinsic muscle wasting – claw toes Equinus contracture
Slide 12-

Sensory Neuropathy Loss of protective sensation Starts distally and migrates proximally in “stocking” distribution Large fibre loss – light touch and proprioception Small fibre loss – pain and temperature Usually a combination of the two
Slide 13-

Sensory Neuropathy Two mechanisms of Ulceration Unacceptable stress few times rock in shoe, glass, burn Acceptable or moderate stress repeatedly Improper shoe s deformity
Slide 14-

Patient Evaluation Medical Vascular Orthopedic Identification of “Foot at Risk”
Slide 15-

Patient Evaluation Semmes-Weinstein Monofilament Aesthesiometer 5.07 (10g) seems to be threshold 90% of ulcer patients can’t feel it Only helpful as a screening tool
Slide 16-

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Slide 17-

Patient Evaluation Medical Optimized glucose control Decreases by 50% chance of foot problems
Slide 18-

Patient Evaluation Vascular Assessment of peripheral pulses of paramount importance If any concern, vascular assessment ABI (n>0.45) Sclerotic vessels Toe pressures (n>40-50mmHg) TcO2 >30 mmHg Expensive but helpful in amp. level UCMS DELHI
Slide 19-

Patient Evaluation Orthopedic Ulceration Deformity and prominences Contractures UCMS DELHI
Slide 20-

Patient Evaluation X-ray Lead pipe arteries Bony destruction (Charcot or osteomyelitis) UCMS DELHI
Slide 21-

Patient Evaluation UCMS DELHI
Slide 22-

Patient Evaluation Nuclear medicine Overused Combination Bone scan and Indium scan can be helpful in questionable cases (i.e. Normal X-rays) Gallium scan useless in these patients Best screen – indium – and if Positive – bone scan to differentiate between bone and soft tissue infection UCMS DELHI
Slide 23-

Patient Evaluation CT can be helpful in visualizing bony anatomy for abscess, extent of disease MRI has a role instead of nuclear medicine scans in uncertain cases of osteomyelitis UCMS DELHI
Slide 24-

Ulcer Classification Wagner’s Classification 0 – Intact skin (impending ulcer) 1 – superficial 2 – deep to tendon bone or ligament 3 - osteomyelitis 4 – gangrene of toes or forefoot 5 – gangrene of entire foot UCMS DELHI
Slide 25-

ClassificationType 2 or 3 UCMS DELHI
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ClassificationType 4 UCMS DELHI
Slide 27-

Treatment Patient education Ambulation Shoe ware Skin and nail care Avoiding injury Hot water F.B’s UCMS DELHI
Slide 28-

Six intervention demonstrate efficacy in diabetic foot management 1- off loading 2- Debridement and drainage 3- wound dressing 4- appropriate use of antibiotic 5- revascularization 6- limited amputation
Slide 29-

Treatment Wagner 0-2 Total contact cast Distributes pressure and allows patients to continue ambulation Principles of application Changes, Padding, removal Antibiotics if infected
Slide 30-

Treatment
Slide 31-

Treatment Wagner 0-2 Surgical if deformity present that will reulcerate Correct deformity exostectomy
Slide 32-

Treatment Wagner 3 Excision of infected bone Wound allowed to granulate Grafting (skin or bone) not generally effective
Slide 33-

Treatment Wagner 4-5 Amputation ? level
Slide 34-

5 P’s 3D’s
Slide 35-

Treatment After ulcer healed Orthopedic shoes with accommodative (custom made insert) Education to prevent recurrence
Slide 36-

Charcot Foot More dramatic – less common 1% Severe non-infective bony collapse with secondary ulceration Two theories Neurotraumatic Neurovascular
Slide 37-

Charcot Foot Neurotraumatic Decreased sensation + repetitive trauma = joint and bone collapse Neurovascular Increased blood flow → increased osteoclast activity → osteopenia → Bony collapse Glycolization of ligaments → brittle and fail → Joint collapse
Slide 38-

Classification Eichenholtz 1 – acute inflammatory process Often mistaken for infection 2 – coalescing phase 3 - consolidation
Slide 39-

Indications for Amputation Uncontrollable infection or sepsis Inability to obtain a plantar grade, dry foot that can tolerate weight bearing Non-ambulatory patient Decision not always straightforward
Slide 40-

Conclusion Multi-disciplinary approach needed Going to be an increasing problem High morbidity and cost Solution is probably in prevention Most feet can be spared…at least for a while
Slide 41-

Prevention Diabetic control Foot care
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Slide 43-

Diabetic foot successfully treated !!