Review Article: Diabetic Foot in the Arab World: An Update
|
|
- Julianna Griffin
- 6 years ago
- Views:
Transcription
1 Med. J. Cairo Univ., Vol. 81, No. 1, December: , Review Article: Diabetic Foot in the Arab World: An Update ELSAYED ALSALAMONY, M.D. The Department of Internal Medicine, Faculty of Medicine, Mansoura University Abstract While diabetic foot problem was discussed in many papers throughout the world, unfortunately it has not discussed well in the Arab World. The global epidemic of diabetes has not spared the Arabic-speaking countries; this has not been fully appreciated in the world's literature. In this paper, we clarify why it is more prevalent, less managed and has been associated with worse health outcomes in diabetic patients in the Arab world. Key Words: Diabetic foot Arab world Diabetes. Introduction DIABETES mellitus, long considered a disease of minor significance to world health [1], is now considered a global epidemic of the 21 st century. The International Diabetes Federation (IDF) estimates show that for the year 2012, 371 million people are living with diabetes, representing a prevalence rate of 8.3%. Estimates also show that 50% of diabetics do not know that they have the condition, as it has not been diagnosed yet [2]. By 2030, the global burden of diabetes is projected to reach 552 million people [1], with a 69% increase in the number of adults with diabetes in developing countries and a 20% increase in developed countries [3]. The Arab world refers to Arabic speaking countries expanded from the Atlantic Ocean in the west to the Arabian Gulf in the east and from the Mediterranean Sea in the north to the horn of Africa and Indian Ocean in the southeast, the prevalence of type II diabetes has increased dramatically in the Arabic-speaking countries over the last three decades, a trend that parallels increased industrial development. The wealth generated by oil-rich resources in countries of the Arabian Gulf have led to improved living standards, while there have also been accelerated urbanization, drastic changes in nutrition, reduced physical activity, and a greater Correspondence to: Dr. Elsayed M. Alsalamony, ssalamony2002@yahoo.com reliance on mechanization and migrant workers. As many as six Arabic-speaking countries are among the world s leaders in terms of type II diabetes prevalence: These countries are SA is ranked with the 6 th highest prevalence of diabetes worldwide, and is expected to hold this position for the next 20 years, with a prevalence rate of 20.0% among year-old adults [5]. Other countries ranked in the top 10 include Kuwait (21.1%), Lebanon (20.2%), Bahrain (19.9%) and the United Arab Emirates (19.2%) [4]. The prevalence of diabetes mellitus DM in SA varies among studies [5-7], principally because of differences in research methodologies. Al-Nozha et al., [6] conducted a well-designed national survey and reported a prevalence rate of 23.7% in adult Saudis aged >30 years (26.2% in males versus 21.5% in females). Table (1) provides the 2010 International Diabetes Federation (IDF) statistics for type II diabetes prevalence in developed and developing countries. An estimated 9.1 % of the populations from the Middle Eastern/North African region have type II diabetes (32.8 million) in 2011, and this is projected to reach 60 million in As for type I diabetes in the Middle Eastern/North African region, Saudi Arabia has the largest number of cases (65,000) of T1DM in children aged 0-14 years, while Kuwait has the highest incidence rate (22 cases per 100,000 per year) [4]. Table (1): Arab countries located in the East have among the top ten highest diabetes prevalences in the list pub lished by the IDF (Table 2). Country (2007) Country (2005) 1 Nauru 1 Nauru 2 United Arab of Emirates 2 United Arab of Emirates 3 Saudi Arabia 3 Saudi Arabia 4 Bahrain 4 Bahrain 5 Kuwait 5 Kuwait 6 Tonga 6 Oman 7 Oman 7 Tonga 8 9 Mauritius Egypt 8 9 Mauritius Egypt 10 Mexico 10 Mexico 1125
2 1126 Diabetic Foot in the Arab World: An Update Data accumulated over the last 30 years have confirmed that the epidemic of type 2 diabetes is mainly affecting Saudi Arabia SA and adjacent Gulf Council Countries GCC. Indeed). In Sudan knowledge of diabetes epidemic in Sudan is limited the most recent data come from small scales study that was carried out in 1996 the result of the study indicate prevalence of 3-4% but recent estimates place the diabetes population at around one million 95% of whom have type 2 diabetes [8]. Diabetic foot syndrome: Foot disorders are among the most feared chronic complications of DM. Diabetic foot disease comprise a group of disorders that often present with at least one of the following clinical manifestations: Foot ulceration, infection, neuropathy, deformity, gangrene and ischemia. Some or all of these problems may develop in the same patient, often on both feet. If not treated in a timely and appropriate, amputation will become necessary [9], In turn, amputation is often associated with significant morbidity and mortality [10] in addition to immense social, psychological and financial consequences [11-13]. A person with diabetes has a 15% to 25% lifetime chance of developing a foot ulcer and a 50% to 70% recurrence rate over the ensuing 5 years. A foot ulcer precedes lower-limb amputation in 85% of cases [14]. The 1-year amputation rate of a person with diabetes and a foot ulcer is 15% [15]. The presence of diabetes increases the risk of a nontraumatic lower-limb amputation 20-fold, and worldwide 25% to 90% of amputations, especially nontraumatic lower-limb loss, are associated with diabetes [16]. Moreover, according to some conservative estimates, the treatment costs of these complications account for approximately 25% of total hospital costs of diabetes care, the true costs of which might be an order of magnitude higher [17]. In Saudi Arabia, Alwahabi, 2006 stated that diabetic foot problems throughout the world, but few has been written about the problem in the Middle East and even in the Arab world. After reviewing some discussions, we realized that the magnitude of the problem is not yet appreciated for many reasons [7]. Jaffar and Jane were conducted a study to evaluate associated risk factors, clinical presentation, and outcome of diabetic foot ulcers (DFUs) in a Saudi Arabian hospital and they found that DFUs continue to be an important cause of morbidity and resulted in an amputation rate of 19% [18]. In Sudan, Similar to other African countries, diabetes is no longer rare in Sudan. The country's resource strained health care system is far from ready to deal with the rising burden of diabetes. Superficial heel ulcers in diabetic patients with a short history of diabetes and with good limb circulation are more likely to heal within an average duration of 25 weeks. At 3 years of follow-up, 75% showed a favorable outcome for ulcer healing, and 22 patients underwent lower extremity amputation (25%), of whom 14 were dead within 3 years [8]. Pathogenesis: Diabetes can lead to serious complications if it is not properly managed: Most of these complications are related to complications arising from microvascular (e.g., nephropathy, neuropathy, and retinopathy and macrovascular (e.g., coronary artery disease (CAD), peripheral artery disease (PAD), and cerebrovascular disease [19]. Studies have shown that people with peripheral neuropathy (PNP), and peripheral vascular diseases (PVD) are known to be at high risk of foot complications [20]. Diabetic neuropathy: DPN is thought to result from multiple factors. Putative mechanisms for the development of DPN include glycosylation of neural proteins, microangiopathy, the development of neural autoantibodies, and ischemia from basement membrane thickening of the nerve capillaries (vaso nervorum). Abnormalities of the polyol pathway and defects in metabolism of myoinositol and protein kinase C3 leading to neuronal demyelination have also been described in DPN [21]. Peripheral neuropathy may cause loss of sensation in the feet, resulting in a patient's failure to perceive foot problems, and may cause development of foot deformities that increase pressure points susceptible to ulceration. Osteomyelitis and gangrene may develop from inadequate blood supply and infection [22]. All nerve fibers (sensory, motor, and autonomic) are affected in diabetic peripheral neuropathy. Studies in the Arab world showed a prevalence range of neuropathy from 38-94% in diabetic foot cases [23]. Data from the Western part of Saudi Arabia indicates that the prevalence of neuropathy in diabetic patients is about 82% (which is considered one of the highest in the world) with another 57% being asymptomatic [24]. In a cross-sectional study from Egypt, 22% had peripheral neuropathy and 0.8% had foot ulcers
3 Elsayed Alsalamony 1127 [25]. In Jordan, 5% had amputations (88). At a diabetic clinic in Libya 45% had neuropathy [26]. In the UAE the overall prevalence of PN was 39%, which was higher than the equivalent rates reported in other populations [27]. Peripheral vascular disease was defined as the presence of ischemic symptoms such as, or a combination of, intermittent claudication, absence of pedal pulse, arterial occlusion, or decreased blood circulation to the foot on Doppler study [28]. Patients have a 2-4 fold greater risk of developing CAD and PAD than non diabetic individuals [29]. It has been proven by many studies that age, duration of diabetes; hypertension and smoking are the risk factors for the development of peripheral vascular disease in diabetics. It is not clear yet if hyperglycemia, hyperinsulinemia and some types of lipids are risk factors for atherosclerosis in diabetes [30]. In the Arab world, peripheral arterial disease is commonly found in diabetics with a prevalence range of % [23]. Clinical presentation: The diabetic foot have 2 categories: The neuropathic foot and the neuroischemic foot. Both categories could be accompanied by infection with different severities. The neuropathic foot (ulcer): It occurs at sites of high mechanical pressure on the plantar surface of the foot, commonly at the head of metatarsal bones and usually proceeded by callus formation. Due to hot climate, the common footwear's used are slippers or sandals. These sandals or slippers has a ridge that fits between the first and the second toe. Neuropathic ulcers were commonly observed at the first web space and sometimes too advance that necessitates amputation. Neuropathic ulcers which are small and not infected are rarely seen due to its delayed presentation [7]. Charcot neuroarthropathy: Charcot deformity is a neuroarthropathy of the foot and ankle. The most common area of manifestation is in the midfoot, followed by the forefoot and ankle region. This presents as hot, red, swollen foot, ankle or lower leg that is most often confused with cellulitis, DVT or gout in the early phase. The average time of delay to proper diagnosis is 29 weeks. Prompt treatment with offloading of the foot with a removable walking boot or short leg cast and crutches, wheelchair or rollabout prevents progressive collapse of the foot. It is this collapse of the foot that can lead to callus formation, ulceration, infection and amputation [31]. The neuroischemic foot (ulcer): Ulcers often occur from localized pressure of tight shoes. One of the precipitating factors of ulcers and even infection and gangrene is wound caused by trimming of nails. The neuroischemic ulcers have a significantly poorer outcome compared to neuropathic ulcers because of the blood supply. Infection is multimicrobial. In local studies Staphylococcus aureus, Pseudomonas Argenosa, and Proteus mirabilis, were the most common bacteria (Fig. 1) [23]. Fig. (1): Diabetes mellitus is responsible for a variety of foot pathologies contributing to the complications of ulce-ration and amputation. Multiple pathologies may be implicated, from vascular disease to neuropathy to mechanical trauma.
4 1128 Diabetic Foot in the Arab World: An Update Investigations: Ankle brachial index which could be falsely high. Transcutaneous oxygen (Tco2) also could be falsely normal because of shunting due to peripheral neuropathy. Toe pressure is probably the most sensitive noninvasive test because of sparing of diabetic vascular changed to the digital arteries. It has been our policy that any diabetic foot ulcer with absent palpable distal pulses should be referred to vascular surgery for further work up. Selective angiography with minimal contrast still our standard investigation. Most of the time, we carried out distal revascularization with >90% limb salvage [7]. Diabetic foot in the Arab world: In the Arab world, several factors make diabetic foot prevalence higher as compared to the West (Table 2): I- Weather and footwear: In most Arab countries the weather is hot and dry most of the year. This makes the habit of wearing closed shoes and socks rejected by many patients and instead they prefer to wear sandals. Sandals do not offer the protection afforded by closed foot wear since they expose feet to heat, dryness and injuries [32]. II- Habits: Walking bare-footed especially inside the home is still a common habit in many regions of the Arab world [32]. III- Religion: Ninety percent (90%) of Arab populations are Muslims. They pray five times per day where the feet have to be washed before praying. These maneuvers help patients to inspect their feet as well as clean them. Washing feet before praying and the praying itself offer some sort of physical massage to the feet. Trimming the nails is a habit encouraged by Islam, but it should be done properly so as not to harm the toes. Also, every year millions of Muslims engage in the holy practice of Hajj. Among them are many persons with diabetes who may sustain unnoticed physical harm to their feet. Diabetes education and foot care is therefore an important issue before going to do Hajj [32]. IV- Education: The percentage of illiterate people is higher in the Arab world than in western countries. Lack of education leads to unawareness of diabetic foot problems and their prevention. Interestingly, one study showed that 90% of screened diabetic patients had poor knowledge about their disease and 96.3% had poor awareness about its control [33]. V- Media: In some Arab countries, the mediahas an inadequate attention to the health problemsin general and nothing about diabetic foot problems. Recently, few articles were published seeking medical attention promptly at the earliest onset of symptoms [7]. Table (2): Risk factors for diabetic foot complications, Arab world versus Western world [7]. Affecting factors Arab world Western world Weather and foot wear Habits Religion Education Media Traditional Medicine Surgery Phobia Health care system Health care providers Community factor Rehabilitation Hot, dry weather, sandals for shoes Walking bare foot still common (Ablution) Washing for prayer five times a day leads to regular foot inspection Patients information about diabetes and its complication is still developing. High prevalence of illiterate old patients Poor in health education Cautery, herbal medicine and blood letting, still understudied and commonly used Poor education is leading to surgery phobia Patients have to be referred by primary care physician to the specialist Low awareness of the magnitude of the problem and standard management Strong believe in traditional medicine, delayed presentation Still sub optimal Cold, wet, protective shoes Rare Patients are more educated Advanced Doesn't exist Patients are more educated and less anxious to seek medical advise early Diabetic foot clinics are more available More knowledge about the problem Only modern medicine is practiced, early presentation Advanced
5 Elsayed Alsalamony 1129 VI- Traditional medicine: This is one of the most important factor in my opinion that led to high prevalence of diabetic foot problems in the Arab world. A) Herbal medicine-herbal medications are still commonly used and most of the time they complicate or obstruct the treatment of modern medicine. Local healers use different kind of local herbs of a broad spectrum to cure many illnesses [34]. With all the explanation and education spent on trying to convince the public to avoid this kind of traditional medicine; still it is a very common practice. Cautery-since ancient times it is a common belief that cautery is the treatment of choice or the last resort to many diseases. Local healers use heated iron rods of various sizes and shapes with either sharp or pointed ends while they are glowing red. The heated end of the instrument is used by either employing the fine touch or firm pressure. The site of the application varies with different disease. In the diabetic foot, it is commonly seen in the dorsum of the foot or the lateral aspect of the lower leg. We observed some cases complicated with wound infection due to delayed presentation, often leading to amputation. C- Blood-letting-there is a believe that in certain diseases the blood is bad and the body must get rid of this evil blood. Like in cauterization, there are different sites of blood-letting according to the disease. In the diabetic foot, it is carried out at the ankle. The skin is cut into small multiple cuts then an inverted cup is applied with a match burning inside, immediately before it is applied the match is put off. This will create suction on the skin. An average of ml of blood is let [34]. VII- Surgery phobia: A very common reason for the delayed presentation of the diabetic foot even in educated patients, is the fear of surgery or amputation. People believe in our part of the world that they should not loose any part of their body even if this leads to death [7]. VIII- Health care system and health care providers: Health resources available for diabetes care and diabetic foot management differs considerably among Arab countries and still the management of the diabetic foot is not based on a multidisciplinary team approach. Due to the frequency and long hospital stays, diabetic foot cases usually consume a considerable part of the health care budgets. For this reason the hospitals administrative staff and health care providers are somewhat reluctant to admit patients with diabetic foot problems in their early presentation. This of course results in more complicated problems and subsequently, more amputations [32]. IX- Community factor: Due to a single story for example about a patient who went to the hospital to treat his diabetic foot and ended up by a major amputation or death and in the other hand another patient tried traditional medicine first and got cured, the repercussion would be that most of the patients will try traditional medicine first and will take recourse to the hospitals at a late stage of the disease and end up with an amputation, such as the vicious cycle! [7]. Amputation or death Fig. (2): Vicious circle. X- Rehabilatation: Physical and social rehabilitation is still an underdeveloped field in Arab countries. Patients with amputations may wait for a long time before they can be provided with an orthotic device. Frequently the cost inhibits the patient from seeking appropriate help. Unfortunately, patients isolate themselves after amputation and live a lonely, depressed life. In addition to this, a lack of employment for amputees has a very negative impact on their life and that of their families [32]. Management: International studies and guidelines show that targeted foot care and proper screening of risk cases can result in a reduction in the incidence of foot ulcers in patients with diabetes [35]. National Diabetes Programme was established in June 2010 under the Clinical Strategy and Programmes Directorate. In 2011 funding was received to establish a national multidisciplinary foot care service for people with diabetes [36]. Foot care management in diabetes is based on three categories of risk: 1- Patients at low risk of diabetic foot disease will be managed preventatively through annual screening and regular foot inspections/examinations by primary care nurses*.
6 1130 Diabetic Foot in the Arab World: An Update (Definition: A low risk foot patient has normal foot pulses, normal vibration and sensation to 10g monofilament, no history of foot ulceration, no significant foot deformity, or no visual impairment). 2- Patients at risk of diabetic foot disease may be stratified as either moderate risk or high risk. All patients will be under regular surveillance by primary care nurses/general practitioners#. Moderate risk patients will be referred by the GP to the podiatrist, either in the community or in the hospital, for an annual review. These patients will remain under the clinical governance of the GP and podiatrist #. (Definition: The moderate-risk patient has either impaired peripheral sensation or impaired circulation or significant visual impairment or a structural foot deformity). High risk patients will be called to be seen at least annually by the diabetes foot protection team in one of the 16 designated centres, and will be under the governance of the foot protection team for their foot care. (Definition: The high-risk patient has an abnormality that predisposes them to foot ulceration. This can be impaired sensation and impaired circulation, or a previous foot ulcer, previous lower limb amputation or previous Charcot foot). 3- Patients with active diabetic foot disease, defined as patients with an active foot ulcer (defined as a full thickness skin break) or a Charcot foot, will be actively managed by a multidisciplinary specialist foot care service, in conjunction with vascular surgery, orthopaedics and orthotics input as required. Nonetheless, the future is looking promising as there are many efforts to improve the outcome of diabetes and its complications in many Arab countries. References 1- S. WILD, G. ROGLIC, A. GREEN, R. SICREE and H. KING: Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030, Diabetes Care, Vol. 27, No. 5, pp , International Diabetes Federation. Diabetes Atlas, 5 th Edition. Update, SHAW J.E., SICREE R.A. and ZIMMET P.Z.: Global estimates of the prevalence of diabetes for and Diabetes Res. Clin. Pract., 87: 4-14, International Diabetes Federation, IDF Diabetes Atlas, International Diabetes Federation, Brussels, Belgium, 5 th edition, ELHADAD T.A., AL-AMOUDI A.A. and ALZAHRANI A.S.: Epidemiology, clinical and complications profile of diabetes in Saudi Arabia: A review. Ann. Saudi Med., 27: , AL-NOZHA M.M., AL-MATOUQ M.A., AL-MAZROU Y.Y., AL-HARTHI S.S., ARAFAH M.R., KHALIL M.Z., KHAN N.B., AL-KHADRA A., AL-MARZOUKI K., NOUH M.S., ABDULLAH M., ATTAS O., AL-SHAHID M.S. and AL-MOBEIREEK A.: Diabetes mellitus in Saudi Arabia. Saudi Med. J., 25: , AL-WAHBI A.M.: The diabetic foot in Arab world. Saudi Med. J., 27: , AZEVEDO M. and ALLA S.: Diabetes in Sub-Saharan Africa: Kenya, Mali, Mozambique, Nigeria, South Africa and Zambia School of Health Sciences & College of Public Service, Jackson State University, International Journal of Diabetes in Developing Countries, Mississippi, USA, Oct-Dec., 28 (4): , AL-TAWFIQ J.A. and JOHNDROW J.A.: Presentation and outcome of diabetic foot ulcers in Saudi Arabian patients. Adv. Skin Wound Care, 22: , ROBBINS J.M., STRAUSS G., ARON D., LONG J., KUBA J. and KAPLAN Y.: Mortality rates and diabetic foot ulcers: Is it time to communicate mortality risk to patients with diabetic foot ulceration? J. Am. Podiatr. Med. Assoc., 98: , BOUTOILLE D., FERAILLE A., MAULAZ D. and KREMPF M.: Quality of life with diabetes-associated foot complications: Comparison between lower limb amputations and chronic foot ulceration. Foot Ankle. Int., 29: , ALZAHRANI H.A. and SEHLO M.J.: The impact of religious connectedness on health-related quality of life in patients with diabetic foot ulcers. J. Relig. Health, Aug. 24. (Epub ahead of print), KALISH J. and HAMDAN A.: Management of diabetic foot problems. J. Vasc. Surg., 51: , BREM H., SHEEHAN P., ROSENBERG H.J., SCHNEIDER J. S. and BOULTON A.J.: Evidence-based protocol for diabetic foot ulcers. Plast Reconstr Surg., 117 (Suppl 7): 193S-209S; discussion 10S-11S, LAVERY L.A., VAN HOUTUM W.H. and HARKLESS L.B.: In-hospital mortality and disposition of diabeticamputees in the Netherlands. Diabetic. Med., 13: 192-7, LAVERY L.A., ARMSTRONG D.G., VELA S.A., QUEBEDEAUX T.L. and FLEISCHLI J.G.: Practical criteria for screening patients at high risk for diabetic foot ulceration. Arch. Intern. Med., 158: , SONGER T.J.: The role of cost-effectiveness analysis and health insurance in diabetes care. Diabetes Res. Clin. Pract., 54 (Suppl 1): S7-11, JAFFAR A.T. and JANE A.J.: Presentation and Outcome of Diabetic Foot Ulcers in Saudi Arabian Patients. Advances in skin and wound care: March, Volume 22, Issue 3 p, H.E. RESNICK, K.B. STANSBERRY, T.B. HARRIS, et al.: Diabetes, peripheral neuropathy, and old age disability, Muscle and Nerve, Vol. 25, No. 1, pp , SHOJAIEFARD A., KHORGAMI Z. and LARIJANI B.:
7 Elsayed Alsalamony 1131 Independent risk factors for amputation in diabetic foot. Int. J. Diabetes. Dev. Ctries, 28: 32-37, TANENBERG R.J. and DONOFRIO P.D.: Neuropathic problems of the lower extremities in diabetic patients. In: Bowker J.H., Pfeifer M.A., editors. Levin and O'Neal's the diabetic foot, 7th ed. St. Louis: Mosby, DARGIS V., PANTELEJEVA O., JONUSHAITE A., VILEIKYTE L. and BOULTON A.J.: Benefits of a multidisciplinary approach in the management of recurrent diabetic foot ulceration in Lithuania: A prospective study. Diabetes Care, 22: , QARI F.A. and AL-BAR D.: Diabetic foot: Presentation and treatment. Saudi Med. J., 21: , D.H. AKBAR, S.A. MIRA, T.H. ZAWAWI and H.M. MALIBARY: Subclinical diabetic neuropathy: A common complication in Saudi diabetics, Saudi Medical Journal, Vol. 21, No. 5, pp , W.H. HERMAN, R.E. AUBERT, M.M. ENGELGAU, et al., Diabetes mellitus in Egypt: Glycaemic control and microvascular and neuropathic complications, Diabetic Medicine, Vol. 15, No. 12, pp , A.K. S. JBOUR, N.S. JARRAH, A.M. RADAIDEH, et al.: Prevalence and predictors of diabetic foot syndrome in type 2 diabetes mellitus in Jordan, Saudi Medical Journal, Vol. 24, No. 7, pp , F.A. MASKARI and M. EL-SADIG: " Prevalence of risk factors for diabetic foot complications"bmc Family Practice, 8: 59, NOVO S.: Classification, epidemiology, risk factors, and natural history of peripheral arterial disease. Diabetes Obes. Metab., 4: S1-S6, A.B. NEWMAN, D.S. SISCOVICK, T.A. MANOLIO, et al.: Anklearmindex as amarker of atherosclerosis in the cardiovascular health study, Circulation, Vol. 88, No. 3, pp , BOWKER J.H. and PFEITER M.A.: editors. Levin and ONeals: The Diabetic Foot. 6 th ed. St. Louis (USA): Mosby, p , ARMSTRONG D.G., TODD W.F., LAVERY L.A., HAR- KLESS L.B. and BUSHMAN T.R.: The natural history of acute Charcot's arthropathy in a diabetic foot specialty clinic. J. Am. Podiatr. Med. Assoc. Jun., 87 (6): 272-8, A.A. AHMED, E. ELSHARIE and A. ALSHARIEF: The Diabetic Foot in the Arab World. Journal of Diabetic Foot Complications, Volume 3, Issue 3, No. 3, Pages 55-61, ELBAGIR M.N., ELTOM M.A., ELMAHDI E.M., KAD- AM I.M. and BERNE C.: A population based study of the prevalence diabetes and impaired glucose tolerance in adults in northern Sudan. Diabetes Care, 19: , AL-AWAMY B.H.: Evaluation of commonly used tribal and traditional remedies in Saudi Arabia. Saudi Med. J., 22: , SIGN Scottish Intercollegiate Guidelines Network. Management of diabetes, a national clinical guideline. NHS Quality Improvement Scotland, National Diabetes Programme Clinical Strategy and Programmes Directorate. clinical/natclinprog/modelofcarediabetes, 2011.
Diabetic Foot Ulcers. Alex Khan APRN ACNS-BC MSN CWCN CFCN WCN-C. Advanced Practice Nurse / Adult Clinical Nurse Specialist
Diabetic Foot Ulcers Alex Khan APRN ACNS-BC MSN CWCN CFCN WCN-C Advanced Practice Nurse / Adult Clinical Nurse Specialist Organization of Wound Care Nurses www.woundcarenurses.org Objectives Identify Diabetic/Neuropathic
More informationHigh Risk Podiatry in a Vascular Setting; A new paradigm in Diabetic Foot Disease? Ereena Torpey Senior Podiatrist - FMC
High Risk Podiatry in a Vascular Setting; A new paradigm in Diabetic Foot Disease? Ereena Torpey Senior Podiatrist - FMC A new paradigm? Foot ulceration 101 Assessing Perfusion a new challenge Pressure
More informationHow can DIABETES affect my FEET? Emma Howard Specialist Podiatrist and Team Leader, Oxford Health NHS Foundation Trust
How can DIABETES affect my FEET? By: Emma Howard Specialist Podiatrist and Team Leader, Oxford Health NHS Foundation Trust HOW CAN DIABETES AFFECT MY FEET? What is neuropathy? This leaflet explains how
More informationThe Diabetic Foot Screen and Management Foundation Series of Modules for Primary Care
The Diabetic Foot Screen and Management Foundation Series of Modules for Primary Care Anita Murray - Senior Podiatrist Diabetes, SCH Learning Outcomes Knowledge of the Model of Care For The Diabetic Foot
More informationClinical assessment of diabetic foot in 5 minutes
Clinical assessment of diabetic foot in 5 minutes Assoc. Prof. N. Tentolouris, MD 1 st Department of Propaedeutic Internal Medicine Medical School Laiko General Hospital Leading Innovative Vascular Education
More informationDIABETIC FOOT RISK CLASSIFICATION IN A TERTIARY CARE TEACHING HOSPITAL OF PESHAWAR
ORIGINAL ARTICLE DIABETIC FOOT RISK CLASSIFICATION IN A TERTIARY CARE TEACHING HOSPITAL OF PESHAWAR Ghulam Shabbier, Said Amin, Ishaq Khattak, Sadeeq-ur-Rehman Department of Medicine Khyber Teaching Hospital
More informationDIABETIC FOOT SCOPE OF THE PROBLEM. Hanan Gawish, Mansoura University Egypt Representative of the IWGDF
DIABETIC FOOT SCOPE OF THE PROBLEM Hanan Gawish, Mansoura University Egypt Representative of the IWGDF Agenda Definition of DF Diabetic Foot among Diabetes complication Risk factors for amputation Risk
More informationManagement Of The Diabetic foot
Management Of The Diabetic foot Aims, Pathways, Treatments Nikki Coates 12/1/18 Diabetic foot pathology Neuropathy Foot deformity Vascular disease Sensory neuropathy Limited Joint Mobility Smoking Autonomic
More informationDiabetic/Neuropathic Foot Ulcer Assessment Guide South West Regional Wound Care Program Last Updated April 7,
Developed in collaboration with the Wound Care Champions, Wound Care Specialists, Enterostomal Nurses, and South West Regional Wound Care Program (SWRWCP) members from Long Term Care Homes, Hospitals,
More informationCHAPTER.7 CARING THE DIABETIC FOOT
CHAPTER.7 CARING THE DIABETIC FOOT Introduction Diabetes has become a global epidemic(144). The long term complications due to diabetes impose huge social and economic burden, mental and physical misery
More informationRapid Recovery Hyperbarics 9439 Archibald Ave. Suite 104 Rancho Cucamonga CA,
Foot at risk Age Well By Dr LIEW NGOH CHIN Are limb amputations due to diabetes preventable? DIABETES mellitus is a major global health problem and has reached epidemic proportions in many developed and
More informationIntroduction. Epidemiology Pathophysiology Classification Treatment
Diabetic Foot Introduction Epidemiology Pathophysiology Classification Treatment Epidemiology DM largest cause of neuropathy in N.A. 1 million DM patients in Canada Half don t know Foot ulcerations is
More informationPodiatry in Practice. Alan M. Singer, DPM, FACFAS
Podiatry in Practice Alan M. Singer, DPM, FACFAS Podiatry in Practice Alan Singer, D.P.M. UNIVERSITY PODIATRY GROUP Onychomycosis Anti-fungals Onychocryptosis (Ingrown Nails) Ingrown Nails Partial Nail
More informationFoot Ulcer Workshop: Prevention and Management of Diabetic Foot Ulcers. Aparna Pal, Consultant Endocrinologist, RBH Keith Hilston, Podiatrist, BHFT
Foot Ulcer Workshop: Prevention and Management of Diabetic Foot Ulcers Aparna Pal, Consultant Endocrinologist, RBH Keith Hilston, Podiatrist, BHFT High mortality and morbidity Complex condition, longterm
More informationDIABETES AND THE AT-RISK LOWER LIMB:
DIABETES AND THE AT-RISK LOWER LIMB: Shawn M. Cazzell Disclosure of Commercial Support: Dr. Shawn Cazzell reports the following financial relationships: Speakers Bureau: Organogenesis Grants/Research Support:
More informationLOOKING AFTER YOUR FEET
LOOKING AFTER YOUR FEET Looking after your feet Diabetes can affect the nerves and blood supply to the feet. Over years, the nerve endings to the feet can be affected by high blood glucose levels, and
More informationPreventing Foot Ulcers in the Neuropathic Diabetic Foot. Glossary of Terms
Preventing Foot Ulcers in the Neuropathic Diabetic Foot Warren Woods, Certified Orthotist, Health Sciences Centre, Rehabilitation Engineering Department What you need to know Glossary of Terms Neuropathic
More informationThe Diabetic Foot Latest Statistics
The Diabetic Foot Latest Statistics There are 2.6 million people with diagnosed diabetes in the UK. There are predicted to be 500,000 who have the condition but are unaware of it. There are 11,859 in TH
More informationDiabetic/Neuropathic Foot Ulcer Assessment Guide South West Regional Wound Care Program Last Updated June 10,
Developed in collaboration with the Wound Care Champions, Wound Care Specialists, Enterostomal Nurses, and South West Regional Wound Care Program (SWRWCP) members from Long Term Care Homes, Hospitals,
More informationDiabetic Foot Pathophysiology. Professor Donald G. MacLellan Executive Director Health Education & Management Innovations
Diabetic Foot Pathophysiology Professor Donald G. MacLellan Executive Director Health Education & Management Innovations AGEs & RAGEs in Diabetes AGE levels increased & RAGEs highly expressed in diabetic
More informationModel of Care for the Diabetic Foot
Model of Care for the Diabetic Foot National Clinical Programme for Diabetes Clinical Strategy and Programme Division 2018 Revision number Document drafted by National Clinical Programme for Diabetes Working
More informationDiabetes follow-up: What are the PHO Performance Programme goals and how are they best achieved? Supporting the PHO Performance Programme
Diabetes follow-up: What are the PHO Performance Programme goals and how are they best achieved? Supporting the PHO Performance Programme 48 BPJ Issue 39 What are the goals? The PHO Performance Programme
More informationDiabetes - Foot Care
Diabetes - Foot Care Introduction People with diabetes are more likely than others to have problems with their feet. These problems can lead to dangerous infections of the foot. Recognizing and treating
More informationSurgical Off-loading. Reiber et al Goals of Diabetic Foot Surgery 4/28/2012. The most common causal pathway to a diabetic foot ulceration
Reiber et al. 1999 Surgical Off-loading The most common causal pathway to a diabetic foot ulceration Alex Reyzelman DPM Associate Professor California School of Podiatric Medicine at Samuel Merritt University
More informationNational Clinical Conference 2018 Baltimore, MD
National Clinical Conference 2018 Baltimore, MD No relevant financial relationships to disclose Wound Care Referral The patient has been maximized from a vascular standpoint. She has no other options.
More informationHelen Gelly, MD, FUHM, FCCWS
Helen Gelly, MD, FUHM, FCCWS Diabetes mellitus is a major risk factor that impairs wound healing, making foot wounds one of the major problems of diabetes. Over 60% of lower limb amputations in the US
More informationNational Aboriginal Diabetes Association
National Aboriginal Diabetes Association 2015 To increase awareness of diabetes and foot care management Disclaimer: This presentation is offered as educational information and shall not be used as a substitute
More informationStatistics on DM and DFU risk
Disclosure NOTHING Statistics on DM and DFU risk National Institute of Diabetes Digestive & Kidney Diseases: As of September 2011 an estimated 16 million Americans are known to have diabetes, with many
More informationThe Rule of 2s. Diabetic Ankle Fractures: Surgery or No Surgery The Not-So-Straightforward Ankle Fracture. Disclosures. Diabetic Ankle Fractures
Diabetic Ankle Fractures: Surgery or No Surgery The Not-So-Straightforward Ankle Fracture Trauma 101: Fracture Care for the Community Orthopedist, 2018 Ryan Finnan, MD Disclosures No financial disclosures
More informationMy Diabetic Patient Has No Pulses; What Should I Do?
Emily Malgor, MD Assistant Professor of Surgery University of Oklahoma, Oklahoma City My Diabetic Patient Has No Pulses; What Should I Do? There are no disclosures. Background Diabetes affects 387 million
More informationDiabetic Foot Complications
Diabetic Foot Complications Podiatry Specialty Clinic YKHC Bethel, Alaska August 1-3, 2017 Charles C. Edwards, DPM Alaska Native Tribal Health Consortium Peripheral Neuropathy Diabetic Peripheral Neuropathy
More informationAWMA MODULE ACCREDITATION. Module Five: The High Risk Foot (Including the Diabetic Foot)
AWMA MODULE ACCREDITATION Module Five: The High Risk Foot (Including the Diabetic Foot) Introduction - The Australian Wound Management Association Education & Professional Development Sub Committee-(AWMA
More informationDiabetes. HED\ED:NS-BL 037-3rd
Diabetes HED\ED:NS-BL 037-3rd Diabetes Diabetes mellitus is an epidemic disease and based on a recent study published on 2011, the estimated number of affected people is 366 million worldwide and the number
More informationDiabetes Mellitus and the Associated Complications
Understanding and the complications relating to the disease can assist the fitter to better serve patients. and the Associated Complications Released January, 2011 Total: 25.8 million people, or 8.3% of
More informationUNIT FOUR LESSON 11 OUTLINE
UNIT FOUR LESSON 11 OUTLINE Tell participants: Taking care of your feet is an important part of diabetes management. Diabetes is the leading cause of amputations of the lower limbs. In Kentucky, there
More informationDiabetic Foot Ulcer Treatment and Prevention
Diabetic Foot Ulcer Treatment and Prevention Alexander Reyzelman DPM, FACFAS Associate Professor California School of Podiatric Medicine at Samuel Merritt University Diabetic Foot Ulcers One of the most
More informationDiabetes Foot Screening and Risk Stratification Tool
Diabetes Foot Screening and Risk Stratification Tool Welcome to the Diabetes Foot Screening and Risk Stratification Tool This tool is based on the work of the Scottish Foot Action Group (SFAG). It has
More informationUse of Pressure Offloading Devices in Diabetic Foot Ulcers: Do We Practice What We Preach?
Diabetes Care Publish Ahead of Print, published online August 11, 2008 Use of : Do We Practice What We Preach? Stephanie C. Wu, DPM, MSc 2 Jeffrey L. Jensen, DPM 1,3 Anna K. Weber, DPM 3,4 Daniel E. Robinson,
More informationKira Brown & Paige Fallu December 12th, 2017 BME 4013 ROAD: Removable Offloading Adjustable Device
Kira Brown & Paige Fallu December 12th, 2017 BME 4013 ROAD: Removable Offloading Adjustable Device Abstract Diabetes is a costly and devastating disease that affected 382 million people worldwide and cost
More informationRisk factors for recurrent diabetic foot ulcers: Site matters. Received for publication 5 March 2007 and accepted in revised form
Diabetes Care In Press, published online May 16, 2007 Risk factors for recurrent diabetic foot ulcers: Site matters Received for publication 5 March 2007 and accepted in revised form Edgar J.G. Peters
More informationModel of care for the diabetic foot
Model of care for the diabetic foot Item type Authors Citation Publisher Report National Diabetes Programme Working Group National Diabetes Programme Working Group. Model of care for the diabetic foot.
More informationDiabetic Foot Ulcers. Care for Patients in All Settings
Diabetic Foot Ulcers Care for Patients in All Settings Summary This quality standard focuses on care for people who have developed or are at risk of developing a diabetic foot ulcer. The scope of the standard
More informationDIABETIC FOOT BOOK THE. A guide to keeping it simple and preventing complications. Practice genii. the Diabetic Foot Book
DIABETIC THE FOOT BOOK A guide to keeping it simple and preventing complications Understanding how diabetes can affect foot health and the measures that are taken to prevent diabetic foot complications
More informationPerson s Name: ID Number: Date:
South West Regional Wound Care Program Person s Name: ID Number: Interdisciplinary Diabetic/Neuropathic Foot Assessment Form MEDICAL HISTORY: Question Year diabetes diagnosed: Characteristics of onset
More informationPractical Point in Diabetic Foot Care 3-4 July 2017
Diabetic Foot Ulcer : Role of Vascular Surgeon Practical Point in Diabetic Foot Care 3-4 July 2017 Supapong Arworn, MD Division of Vascular and Endovascular Surgery Department of Surgery, Chiang Mai University
More informationPatient Product Information
Patient Product Information REGEN-D 150 (India's First Recombinant Human Epidermal Growth Factor (rhegf) Gel for Diabetic Foot Ulcers) Generic name: [Recombinant Human Epidermal Growth Factor (rhegf)]
More informationVolume 5 Issue 8, August
Effect of Structured Teaching Programme on Knowledge and Practice Regarding Foot Care among Chronic Diabetic Patients Sruthy Vinod Mahatma Gandhi University, Kerala, India Abstract: A study on Effect of
More informationContents. The Diabetic Foot 3. Essentials of Diabetic Foot Care 5. Numbness in Feet, But No Diabetes? Here s What Else It Could Be 7
Contents The Diabetic Foot 3 Essentials of Diabetic Foot Care 5 Numbness in Feet, But No Diabetes? Here s What Else It Could Be 7 Proper Shoes For Diabetics 9 How to Treat and Prevent a Diabetic Foot Ulcer
More informationEVALUATION OF THE VASCULAR STATUS OF DIABETIC WOUNDS Travis Littman, MD NorthWest Surgical Specialists
EVALUATION OF THE VASCULAR STATUS OF DIABETIC WOUNDS Travis Littman, MD NorthWest Surgical Specialists Nothing To Disclosure DISCLOSURES I have no outside conflicts of interest, financial incentives, or
More informationTHE DIABETIC FOOT. Nicola Kilburn Diabetes Specialist Podiatrist
THE DIABETIC FOOT Nicola Kilburn Diabetes Specialist Podiatrist Diabetic foot disease is associated with significant morbidity and mortality. Foot screening is effective in identifying an individuals risk
More informationOff Loading, TCC, Shoe 을지의대을지병원 족부정형외과 이경태
Off Loading, TCC, Shoe 을지의대을지병원 족부정형외과 이경태 DMF Protocol VIPS approach V : Vascular I : infection P : Pressure off S : specific wound care Ulcer/Pressure off& Biomechanics PVD vs Peripheral neuropathy NP
More informationDiabetes is a serious disease that can develop from lack of insulin production in the body or due to
Page 1 The Diabetic Foot Definition Diabetes is a serious disease that can develop from lack of insulin production in the body or due to the inability of the body's insulin to perform its normal everyday
More informationDECLARATION OF CONFLICT OF INTEREST. none
DECLARATION OF CONFLICT OF INTEREST none Hypertension and Type 2 Diabetes in The Arab Countries M B BDEIR, MD Director, Cardiac Clinics King Abdulaziz Cardiac Centre, National Guard Health Affairs Riyadh,
More informationStudy on clinical profile of patients attending a tertiary care hospital with diabetic foot from Andhra Pradesh
Original research article Study on clinical profile of patients attending a tertiary care hospital with diabetic foot from Andhra Pradesh Dr Chakrapani Prabhakar Raju MD (General Medicine), Assistant Professor,
More informationPeople with diabetes often have trouble with their feet. Read this booklet to learn 7 steps to help keep your feet healthy.
Form: D-5821 Treat Your Feet: Foot care for people with diabetes People with diabetes often have trouble with their feet. Read this booklet to learn 7 steps to help keep your feet healthy. Diabetes raises
More informationHappy Feet: Feeling good about diabe.c foot screening! Family Medicine Forum 2014, Quebec City November 14, 2014
Happy Feet: Feeling good about diabe.c foot screening! Family Medicine Forum 2014, Quebec City November 14, 2014 Dr. Michael Yan, MD, CCFP Clinical Lecturer, Department of Family Medicine, University of
More informationUSWR 23: Outcome Measure: Non Invasive Arterial Assessment of patients with lower extremity wounds or ulcers for determination of healing potential
USWR 23: Outcome Measure: Non Invasive Arterial Assessment of patients with lower extremity wounds or ulcers for determination of healing potential MEASURE STEWARD: The US Wound Registry [Note: This measure
More informationAGONY FEET. The. of the. Prevention and management of diabetic foot ulcers
The AGONY of the FEET Prevention and management of diabetic foot ulcers By Margaret Falconio-West, BSN, rn, APN/CNS, CWOCN, DAPWCA Nearly 25 percent of people with diabetes will develop a diabetic foot
More informationTraining Your Caregiver: Diabetes
Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate,
More informationDiabetes Foot Care Clinical Pathway Healthcare Provider s Guide
Diabetes Foot Care Clinical Pathway Healthcare Provider s Guide Diabetes, Obesity & Nutrition Strategic Clinical Network Version 1.0 Acknowledgement This healthcare provider s guide has been adapted from
More informationThe Diabetic Foot. Michael Anthony, DPM. 422 million diabetic million % adult population 90% Type II
The Diabetic Foot Michael Anthony, DPM Assistant Professor - Clinical Department of Orthopaedics The Ohio State University Wexner Medical Center Prevalence of Diabetes 422 million diabetic 2016 382 million
More informationThe Diabetic Foot. Prevalence of Diabetes United States. Prevalence of Diabetes
The Diabetic Foot Prevalence of Diabetes Michael Anthony, DPM Assistant Professor - Clinical Department of Orthopaedics The Ohio State University Wexner Medical Center 422 million diabetic 2016 382 million
More informationThe Diabetic foot: An overview. Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit Mansoura University
The Diabetic foot: An overview Mamdouh Radwan El-Nahas Professor of Internal Medicine Diabetes and Endocrinology unit Mansoura University It will be a tragedy if we restrict the term It will be a tragedy
More informationAetiology Macroangiopathy occurs mainly distally ie Popliteal artery There is arterial wall calcification Microangiopathy is less common
DIABETIC FOOT Facts 5% of the population is diabetic 12% of diabetic admissions are with foot problems 1/3rd of diabetic foot ulcerations are neuropathic, 1/3rd are ischaemic and 1/3 are of a mixed in
More informationRapid Foot Screening
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
More informationRenal Foot Care. Christian Pankhurst
Renal Foot Care Christian Pankhurst The consequences of poor management of the renal foot are considerable: prolonged ulceration and ill health, gangrene and amputation, depression and death. The health
More informationFoot Care. Taking steps towards good FOR AT-RISK FEET. HIGH RISK of developing serious. Person with Diabetes
Taking steps towards good Person with Diabetes Foot Care FOR AT-RISK FEET Your healthcare professional has found that as a person with Diabetes your feet have a HIGH RISK of developing serious problems
More informationDiabetes-Diabetes Mellitus About one in five people with diabetes will enter the hospital for foot problems. DIABETIC FOOT PROBLEMS by Robert
Diabetes-Diabetes Mellitus About one in five people with diabetes will enter the hospital for foot problems. DIABETIC FOOT PROBLEMS by Robert Frykberg, DPM Foot problems are leading causes of hospitalization
More informationI also call this lecture
I also call this lecture GO BUCKS!!! My Background Cornerstone University Grand Rapids, MI Kent State University College of Podiatric Medicine (OCPM) Florida Hospital East Orlando 3 year surgical residency
More informationof :07
he diabetic foot ulcer - management and outcomes of 6 3-12-2012 11:07 The diabetic foot ulcer - management and outcomes Impaired perfusion Infection Extent and depth Condition of the ulcer Site Sensation
More informationPractical Point in Holistic Diabetic Foot Care 3 March 2016
Diabetic Foot Ulcer : Vascular Management Practical Point in Holistic Diabetic Foot Care 3 March 2016 Supapong Arworn, MD Division of Vascular and Endovascular Surgery Department of Surgery, Chiang Mai
More informationWill it heal? How to assess the probability of wound healing
Will it heal? How to assess the probability of wound healing Richard F. Neville, M.D. Professor of Surgery Chief, Division of Vascular Surgery George Washington University Limb center case 69 yr old male
More informationDiabetic Foot-Evidence that counts
Bahrain Medical Bulletin, Vol. 28, No. 3, September 2006 Family Physician Corner Diabetic Foot-Evidence that counts Abeer Al-Saweer, MD* Evidence-based medicine has systemized the medical thinking in each
More informationIs Neuropathy the root of all evil in the diabetic foot?
Is Neuropathy the root of all evil in the diabetic foot? Andrew J M Boulton, Manchester UK and Miami, FL Vice-President and Director of International Postgraduate Education, EASD The Global Burden of Diabetes
More informationAddress: Left Leg. other: Nails: thick yellow brittle fungus abnormal thick yellow brittle fungus abnormal
South West Regional Wound Care Toolkit: Interdisciplinary Lower Leg Assessment Form Instructions for use: Competent/ Proficient/ Expert level HCP to complete if lower leg ulcer present or risk of ulcer
More informationClinical Guideline for: Diagnosis and Management of Charcot Foot
Clinical Guideline for: Diagnosis and Management of Charcot Foot SUMMARY This guideline outlines the clinical features of Charcot foot (Charcot Neuroarthropathy). It also explains the process of diagnosis
More informationFoot Care. Taking steps towards good FOR AT-RISK FEET. HIGH RISK of developing serious. Person with Diabetes
Taking steps towards good Person with Diabetes Foot Care FOR AT-RISK FEET Your healthcare professional has found that as a person with Diabetes your feet have a HIGH RISK of developing serious problems
More informationFrank K. Galbraith D.P.M. Dr. Frank Galbraith
Frank K. Galbraith D.P.M. Dr. Frank Galbraith Ingrown Toenails Paronychia (infected toenail) Onychomycosis (fungal nails) From improper trimming, leaving nail sharp corners Curved nails Thick (Hypertrophic)
More informationPeripheral Arterial Disease Extremity
Peripheral Arterial Disease Lower Extremity 05 Contributor Dr Steven Chong Advisors Dr Ashish Anil Dr Tay Jam Chin Introduction Risk Factors Clinical Presentation Classification History PHYSICAL examination
More informationIndian Journal of Basic & Applied Medical Research; December 2011: Issue-1, Vol.-1, P
Original article: Analysis of the Risk Factors, Presentation and Predictors of Outcome in Patients Presenting with Diabetic Foot Ulcers at Tertiary Care Hospital in Karnataka Sarita Kanth Associate Professor,
More informationDIABETES AND FOOTCARE
DIABETES AND FOOTCARE Self-Care and Treatment for Healthy Feet Don t Take Your Feet for Granted Every day, you depend on your feet to keep you moving. But when you have diabetes, your feet need special
More informationDiabetic Feet. Juanita Muller
Diabetic Feet Juanita Muller Mr RR 69 year old male CHARCOT ARTHROPATHY Diabetic Feet Callus Acute injury and ulceration Infection Osteomylitis Chronic ulceration Ischaemic necrosis Charcot s arthropathy
More informationDefinitions and criteria
Several disciplines are involved in the management of diabetic foot disease and having a common vocabulary is essential for clear communication. Thus, based on a review of the literature, the IWGDF has
More informationAssessment of Ulcer Related Outcomes in Type 2 Diabetic Patients with Foot Ulceration in India
Assessment of Ulcer Related Outcomes in Type 2 Diabetic Patients with Foot Ulceration in India Authors: Vijay Viswanathan, MD, PhD 1, Satyavanij Kumpatla, MSc, MTech, PhD 2, Saraswathy Gnanasundaram, ME,
More informationDiabetes Foot and Skin Care. Diabetes and the feet. Foot problems: Major cause of morbidity and mortality
Session # 11 Diabetes Foot and Skin Care Betty Harvey, RNEC BScN MScN Amanda Mikalachki, RN BScN CDE Diabetes and the feet Diabetes affects circulation and immunity. Over time, the sensory nerves in the
More informationA Guide for People With Diabetes. Take Care of Your Feet for a
A Guide for People With Diabetes Take Care of Your Feet for a You can take care of your feet! Do you want to avoid serious foot problems that can lead to a toe, foot, or leg amputation? Take Care of Your
More informationAdminister 60 Second Foot Screen Tool*
Basic Foot Care Screen and Self Care Education Toolkit - Central West Diabetes egional Coordination Centre 2012 Foot Care Screening Flow Map Administer 60 Second Foot Screen Tool* Client Education Throughout
More informationRole of ABI in Detecting and Quantifying Peripheral Arterial Disease
Role of ABI in Detecting and Quantifying Peripheral Arterial Disease Difference in AAA size between US and Surgeon 2 1 0-1 -2-3 0 1 2 3 4 5 6 7 Mean AAA size between US and Surgeon Kathleen G. Raman MD,
More informationPractical guidelines on the management and prevention of the diabetic foot 2011
DIABETES/METABOLISM RESEARCH AND REVIEWS Diabetes Metab Res Rev 2012; 28(Suppl 1): 225 231. Published online in Wiley Online Library (wileyonlinelibrary.com).2253 IWGDF GUIDELINES Practical guidelines
More informationLarry Diaz, MD, FSCAI Mehdi H. Shishehbor, DO, FSCAI
PAD Diagnosis Larry Diaz, MD, FSCAI Metro Health / University of Michigan Health, Wyoming, MI Mehdi H. Shishehbor, DO, FSCAI University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH PAD:
More informationSocio-Economic impact on families with Diabetic Foot Ulcers and Amputations
Socio-Economic impact on families with Diabetic Foot Ulcers and Amputations ABSTRACT Objective: The objective of the study was to examine the socioeconomic risk factors for diabetic & amputations. Design:
More informationPutting feet first: national minimum skills framework
In partnership with Putting feet first: national minimum skills framework The national minimum skills framework for commissioning of footcare services for people with diabetes Revised March 2011 This report
More informationDiabetic Foot Problems
http://www.medicine-on-line.com Diabetic foot disease: 1/12 Diabetic Foot Problems Author: Affiliation: Rebecca Wong BN, MSc(Health Care) Prince of Wales Hospital, Hong Kong SAR Introduction Diabetes Mellitus
More informationPeripheral Neuropathy
Peripheral Neuropathy Neuropathy affects 30-50% of patient population with diabetes and this prevalence tends to increase proportionally with duration of diabetes and dependant on control. Often presents
More information10/19/2017. Shawn M Sanicola DPM, FACFAS Foot And Ankle Associates of WI. Consultant with J&J-Depuy-Synthesis
Shawn M Sanicola DPM, FACFAS Foot And Ankle Associates of WI Consultant with J&J-Depuy-Synthesis Understand the systemic effects of diabetes on the lower extremity The significance of structural and biomechanical
More informationService Development Tool for the Assessment of Provision of Services for Patients with Diabetes Related Foot Problems
Division of Medicine & Community Services Service Development Tool for the Assessment of Provision of Services for Patients with Diabetes Related Foot Problems Graham Holt Advanced Practitioner / Podiatrist
More informationPressure and the diabetic foot: clinical science and offloading techniques
The American Journal of Surgery 187 (Suppl to May 2004) 17S 24S Pressure and the diabetic foot: clinical science and offloading techniques Andrew J. M. Boulton, M.D., F.R.C.P. Department of Medicine, Division
More informationProject I - Background Worksheet. Team Members: Kira Brown, Paige Fallu. Clinical problem Diabetic Foot Ulcers
Project I - Background Worksheet Team Members: Kira Brown, Paige Fallu Clinical problem Diabetic Foot Ulcers 1) Strategic Focus based on the Strategic focus powerpoint presentation and readings a. Team
More informationAn Observational Study on Risk Factors, Complications and Foot Care Practice among Diabetic Foot Ulcer Patients in a Rural Setting
Human Journals Short Communication October 2016 Vol.:7, Issue:3 All rights are reserved by Chintu S Pullan et al. An Observational Study on Risk Factors, Complications and Foot Care Practice among Diabetic
More informationBunions / Hallux Valgus deviation of the big toe
Bunions / Hallux Valgus deviation of the big toe A bunion (hallux valgus) is a deformity of the base joint of the big toe. The cause is not clear in many cases. The deformity may cause the foot to rub
More information