Rapid Foot Screening

Transcription

1 GP Symposium 2015 Workshop Rapid Foot Screening Ms Chelsea Law, Principal Podiatrist Mr Henry Lee, Podiatrist Ms Ng Jia Lin, Podiatrist Ms Polly Lim, Podiatrist Ms Wong Wan Mun, Podiatrist Mr Yeo Boon Kiak, Podiatrist Mr Muhd Afiq, Podiatrist

2 Why foot screening? Prevent catastrophic outcomes with good foot care practices and knowledge MANY FOOT PROBLEMS STEMS FROM POOR FOOTWEAR OR POOR FOOT CARE

3 VASCULAR EXAM FOOTWEAR INSPECTION DERMATOLOGICAL EXAM NEUROLOGICAL EXAM 1 MIN FOOT SCREENING OEDEMA EXAM MUSCULOSKELETAL EXAM IDENTIFYING INFECTION

4 Ms Ng Jia Lin, Podiatrist VASCULAR EXAM

5 Dorsalis Pedis Artery Just lateral to extensor hallucis Palpate with 2 fingers

6 Posterior Tibial Artery Just behind medial malleolus Medial Malleolus

7 Popliteal Artery Behind the knee at middle to medial aspect Best palpated with knee bent slightly and patient completely relaxed

8 Capillary Refill To test for indications of poor peripheral perfusion or dehydration < 3seconds

9 Colour Dark Red / Dusky / Purple

10 Colour Black or Necrotic

11 Visual Assessments Reduced hair growth Thin, shiny skin appearance Temperature gradient from knees down, comparing bilateral legs (eg. warm, cool, cold)

12 Claudication Intermittent claudication 1. Do you get dull ache in your leg when walking? 2. How far can you walk? 3. What happens when you get dull ache? 4. Does it happen after the same distance again? Rest pain 1. Do you have pain in your legs that affects your sleep? 2. What relieves the pain?

13 Ms Polly Lim, Podiatrist NEUROLOGICAL EXAM

14 Previously Monofilament 10g: Ipswich Touch Test (IpTT) Faster Cheaper Convenient Reliable Validated Excellent agreement between both tests (ĸ = 0.88, P < ) Inter-rater agreement for IpTT moderate (ĸ = 0.68) 10 sites x 2 feet = 20 sites (Rayman et al., 2011; Sharma et al., 2014) 3 sites x 2 feet = 6 sites

15 Ipswich Touch Test DO s The touch must be as light as a feather; on apex of 1 st, 3 rd, 5 th toes Brief (1 to 2 seconds) DON Ts Do not attempt to press harder if the patient does not respond Do not touch each toe more than once Neuropathy: 2 6 sites insensate

16 Proprioception test With your eyes close, can you tell me if your big toe is up or down (towards you or away from you)? Hold the distal phalanx of the great toe on either side so that you can flex the interphalangeal joint. Show the patient that when you hold the joint extended, that represents Up whereas when you hold it flexed that represents Down. Ask the patient to close their eyes and, having moved the joint a few times hold it in one position up or down. Ask the patient which position the joint is in.

17 Neurological symptoms Pain Burning Tingling Ants crawling Numbness Pulling sensation Frequent pins and needles

18 Mr Yeo Boon Kiak, Podiatrist MUSCULOSKELETAL EXAM

19 PRESSURE!

20 Intrinsic minus foot Motor neuropathy Lack of muscle stimulation results in atrophic muscles within the foot Digital deformities Distal migration of fat pad Prominent metatarsal heads Intrinsic minus foot Bony prominence = increase risk of pressure/shear/frictional forces

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22 Charcot neuroarthopathy

23 Charcot neuroarthopathy Inflammatory syndrome Varying degrees of bone and joint disorganisation - Secondary to neuropathy, trauma and bone metabolism Rocker-bottom foot - Midfoot collapse

24 Charcot neuroarthopathy Early stage Red, hot, swollen foot May have history of trauma, symptoms of neuropathy No fever Late stage Signs of inflammation absent Rocker bottom deformity

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26 REFER! OFFLOAD!

27 Mr Muhd Afiq, Podiatrist DERMATOLOGICAL EXAM

28 Callus and Corn Before and after debridement of callus

29 Xerosis (Dry Skin)

30 Macerated interdigital / fungal infection

31 Nail conditions Thickened toenail Paronychia Ingrown toenail Haematoma under nail Fungal nail

32 Blisters Blister Blood Blister

33 Ms Wong Wan Mun, Podiatrist FOOTWEAR EXAM

34 Fixation around the ankle Allow shoe to hold onto foot Reduces the development of toe deformities Reduces risk of falling

35 Short heel Reduces forefoot pressure and pain Reduces strain on lower back and knees

36 Cushioning insole

37 Wide toebox Reduces development of bunions Reduces likelihood of blisters and unwanted wounds

38 Deeper toebox Reduces development of toe deformities Reduces likelihood of blisters and unwanted wounds

39 Firm midsole and flexible forefoot Bends at forefoot and not midfoot to provide arch support Allows distribution of pressure at forefoot, reducing callus formation

40 Firm heel counter

41 Soft and breathable upper Allows skin to breathe Reduces risk of blister and fungal infection

42 Ideal features of a supportive footwear Adjustable fastening around ankle Soft cushioning inner sole Soft and breathable uppers Firm heel counter Deep and wide toebox Flexible at forefoot Firm at midfoot Low heel

43 Mr Henry Lee, Podiatrist OEDEMA EXAM

44 Why check for oedema? Oedema can affect wound healing, even if its a small blister or scratch May suggest possibility of fluid overload

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46 Ms Chelsea Law, Principal Podiatrist IDENTIFYING INFECTION

47 Sign & symptoms Red Hot Swollen Pain Fever (not always) Pus / haemoserous discharge But in DM foot, may not have pain Redness may not be significant due to lack of inflammatory response

48 Sign & symptoms Palpation of surrounding tissue reveals bogginess Check for discharge when palpating tissue (pus / serous discharge) Surrounding skin appears very anhidrotic due to excessive warmth (i.e. dry flaky skin) May or may not be associated with open ulcer May have blood clot or blackish appearance due to skin necrosis Blister-like appearance or excessive maceration

49 Cellulitis

50 Bruising

51 Sausage Toes

52 Osteomyelitis / Abscess?

53 Probe to bone

54 Muffin-top

55 PUTTING IT ALL TOGETHER

56 Prevent catastrophic outcomes with good foot care practices and knowledge

57 Callus Callus Thick nails Bunion Thick nails

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59 Putting it all together Low risk Inspect feet every visit Repeat foot screening annually At risk Any identifiable risk factors Refer to a friendly podiatrist for co-management High risk Any signs of infection & presence of wounds Early access to specialist

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