Comprehensive Management Of The Diabetic Foot
Comprehensive Management ofthe Diabetic FootCollin E. Pehde, DPM, FACFASAssistant ProfessorDes Moines UniversityCollege of Podiatric Medicine and SurgeryDMU Foot and Ankle ClinicIowa Affiliate WOCN SocietyFall ConferenceSeptember 13, 2019
Lecture Objectives Understand the comprehensive careapproach to the Diabetic Foot Understand the orthoplastics approach totreat diabetic foot ulcers Understand treatment principles for treatingfoot and ankle Charcot deformity.
Comprehensive Management ofThe Diabetic Foot Maintenance Foot Care Wound Care Limb Salvage– Orthoplastics
Dreaded Complicationsof DiabetesThe Big Three Blindness Kidney Failure Foot and Leg Amputation
The Bad News Amputations usually start out as preventable, easyto treat problems– Calluses, ingrown toenails Once a diabetic has a partial or complete footamputation, he or she is at high risk for furtherbreakdown Rehabilitation of an BKA or AKA with a prosthetic ina diabetic can be extremely difficult Below knee and above knee amputations putsignificant stress on the heart and lungs
Impact of Ulcerations“Foot ulceration is themost common singleprecursor to lowerextremity amputationsamong persons withdiabetes.”JFAS, Diabetic Foot Disorders, Clinical Practice Guidelines
The Diabetic Foot More than 30 million Americans are livingwith diabetes, and more than 84 million USadults have prediabetes. More than 60% of leg and foot amputationsnot related to accidents and injuries areperformed on people with diabetes.November 14, 2018Content source: Centers for Disease Control andPrevention
Diabetic Foot Statistics With appropriate therapy many DFUs willheal and avoid the need for some level ofamputation Recurrence of DFUs in patients is common– 40% within 1 year– 60% within 3 years– 65% within 5 yearsArmstrong et al, “Diabetic Foot Ulcers and Their Recurrence”, NEJM, June 15, 2017, pp2367 - 2375
Diabetic Foot Statistics
THE GOOD NEWSDiabetic FootProblems are readilytreatable and verypreventable!
Realistic Diabetic Foot Care Model Recognize that diabetic foot issues rangefrom the simple to the complex Need to be able to manage complex foot andankle conditions in complex medical patients Recurrence of diabetic foot ulcers is commonbut not a sign of abject failure The high risk diabetic foot needs frequentmonitoring
Ideal Diabetic Foot Management Model“The Diabetic Foot Zone”Goal is to avoid Diabetic Foot Complications No diabetic footcomplicationsAppropriate Foot CareAppropriate Shoes andBracingRegular MedicalProfessional FootChecksPatient in DFU RemissionHow many days ulcer free ? Management of mild tomoderate complicationsMild to moderate InfectionManagement of limbthreatening foot andankle conditionsUlcer ManagementSevere soft tissue andosseous infectionsPeripheral Arterial DiseaseCritical Limb IschemiaStable Charcot DeformityUnstable CharcotDeformityGoal is to transition back to complicationfree state as efficiently as possible
The Diabetic FootGreen Zone Patient Education–Foot-specific individualized patient education is the mostimportant element of a comprehensive diabetic foot program.Prophylactic skin and nail care––Prevention of ingrown toenails and ulcers caused by thickenedtoenailPrevent callus buildupProtective footwear–Protects feet from undo pressure and sheer forcesOnce a problem arises, the patient is instructed to seekmedical attention immediately.–Dealing with problems early on is much easier
Palliative Care
Medical Care
Appropriate Callus Care Non-medicated Corn Pads Pumice Stone Moisturizing lotion Well fitting Shoes and Inserts Professional debridement Surgery to fix deformitiesYES
Avoid Self Sharp DebridementNO
Medicated Corn PadsNO
Luckily, healed uneventfully
Heating Pads and Diabetics Don’t Mix Be Very Cautious!!!
Diabetic
“Charcot foot is a progressive condition characterized by joint dislocation, pathological fractures, and severe destruction of the pedal architecture.” Charcot Foot and Ankle Definition JFAS, Supplement 2000, Diabetic Foot Disorders: A Clinical Practice Guideline, p S39 Complex foot and ankle trauma in complex patients. Depending on
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Diabetic Diet Diabetic Diet for diabetics is simply a balanced healthy diet which is vital for diabetic treatment. The regulation of blood sugar in the non-diabetic is automatic, adjusting to whatever foods are eaten. But, for the diabetic, extra caution is needed to balance food intake with exercise, insulin injections and any other glucose .
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registry, diagnosis of type 2 DM made within last 8 years, diabetic patient on oral hypoglycemic agent, diabetic patient with no h/o diabetic ketoacidosis or end organ damage, diabetic patient with body mass index (BMI) more than or equal to 25 kg/m2 and no recent change in diabetic medication for the last three-month.
