THE DIABETIC FOOT ULLA HELLSTRAND TANG

Transcription

1 THE DIABETIC FOOT ASSESSMENT AND ASSISTIVE DEVICES ULLA HELLSTRAND TANG AVDELNINGEN FÖR ORTOPEDI, INSTITUTIONEN FÖR KLINISKA VETENSKAPER, SAHLGRENSKA AKADEMIN VID GÖTEBORGS UNIVERSITET

2 THE DIABETIC FOOT ASSESSMENT AND ASSISTIVE DEVICES ULLA HELLSTRAND TANG HUVUDHANDLEDARE: JON KARLSSON BIHANDLEDARE: KERSTIN HAGBERG OCH ROY TRANBERG

3 THE DIABETIC FOOT ASSESSMENT AND ASSISTIVE DEVICES A FOOT THAT BELONGS TO A PERSON WITH DIABETES

4 D-Foot Några bilder på D-Foot Foot ulcer

5 Study I-IV N Titel Theme I II III IV Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers. Foot anthropometrics in individuals with diabetes compared with the general Swedish population - implications for shoe design. The D-Foot, an ehealth tool useful in risk classification and foot assessment in diabetes construction and reliability. Comparison of plantar pressure in three types of insole given to patients with diabetes at risk of developing foot ulcers A two-year, randomized trial. Risk factors Foot form D-Foot Insoles

6 Participants Study IV Gothenburg n = 114 ( ) Study III Region Västra Götaland n = 97 ( ) Study I n = 74 ( ) Study II n = 67 ( ) and n = 97 ( )

7 Inclusion criteria diabetes being referred to a department of prosthetic & orthotics (DPO) > 18 år understand the Swedish language exklusionskriterier (Study IV) foot ulcer have previously visited the DPO use walking aids

8 Clinical tests Method

9 Study I Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers Ulla Hellstrand Tang, Roland Zügner, Vera Lisovskaja, Jon Karlsson, Kerstin Hagberg och Roy Tranberg. Diabetic Foot & Ankle, 2015.

10 Aim To describe the presence of risk factors for the development of foot ulcers, to explore the possible association between these risk factors and plantar pressure and finally, to describe the health related quality of life.

11 Method F-Scan

12 Method F-Scan

13

14 STUDIE I Pes transverso planus 77% (57/68) Hallus rigidus 13% (18/69) Pes planus 34% (25/68) Pes cavus10% (7/68)

15 23% STUDIE I

16 38%

17 Results

18 Health related quality of life SF-36 grey= normal population, Sullivan 1995

19 Health related quality of life SF-36 grey= normal population, Sullivan 1995

20 Health related quality of life SF-36 grey= normal population, Sullivan 1995

21 grey= normal population, Sullivan 1995 Health related quality of life SF-36 Individual variation

22 Study II Foot anthropometrics in individuals with diabetes compared with the general Swedish population implications for shoe design Ulla Hellstrand Tang, Jacqueline Siegenthaler, Kerstin Hagberg, Jon Karlsson och Roy Tranberg. The Foot and Ankle Online Journal 10 (3): 1

23 Aim To describe and compare the foot anthropometrics in patients with diabetes compared with the anthropometrics of the general population.

24 Control Diabetes Control Diabetes (Group D) n= 164 Control (Group C) n= 855 Group D N n= Group D D n= Group C 1 n= Group C 2 n= n= 42 n= 60 n= 31 n= 31 n= 253 n= 235 n= 262 n= 105

25 STUDIE II

26 mm mm mm

27 Covariates: age, gender Length mm for Width mm for

28 Covariates: age, gender, and BMI Foot length ns Foot width D N -C 2 (1.6 mm, p=0.047) Index FL/FB D D -C 2 (-0.05 mm, p=0.018)

29 Toe heigth > 25 mm mm mm mm

30 Ulla Hellstrand Tang, Roy Tranberg, Roland Zügner, Jon Karlsson, Vera Lisovskaja, Jacqueline Siegenthaler och Kerstin Hagberg. The Foot and Ankle Online Journal 10 (2): 4 Study III The D-Foot, an ehealth tool useful in risk classification and foot assessment in diabetes construction and reliability

31 Aim To evaluate the reliability of the web application D- Foot, constructed to detect risk factors to develop diabetic foot ulcers.

32 ORGANISATIONSNAMN (ÄNDRA SIDHUVUD VIA FLIKEN INFOGA-SIDHUVUD/SIDFOT)

33 D-Foot Några bilder på D-Foot

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36 Construction D-Foot Reliability Inter Intra N = 102 patients

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38 Reliability Agreement between observers for Yes/No questions Correlation between observers for the continous measurements

39 Results Type of risk factor Neuropathy Inter-reliability (between) Prevalence Agreement Kappa (%) proportion ± CI Pooled Positiv Ipswich Touch Test Foot deformity Amputation Charcot deformity Hallux valgus/varus Calcaneus valgus/varus Abduction/adduktion of the forefoot Prominent bony structure Gait deviation, drop foot Collapsed heel counter medial/lateral Excessively worn-out sole

40 Results continued Type of risk factor Skin Inter-reliability (between) Prevalence Agreement Kappa (%) proportion ± CI Pooled Areas of excessive pressure with callosities Callosities Ulcer Risk grad Risk grade Risk grade Risk grade Risk grade Risk grade total Clinical assessments (potential risk factors) Inappropriate footwear

41 Results continued Type of risk factor Clinical assessments (potential risk factors) Insufficient function of the toes and metatarsal phalangeal joints Gait deviation, affected from hip/knee right and left respectively Inter-reliability (between) Prevalence Agreement Kappa (%) proportion ± CI Pooled

42 Results Type of risk factor Inter-reliability (between) Mean Diff. Pearsons r ICC Foot deformity Toe height (mm) Passive dorsal flexion at hallux joint (degree) Maximal dorsal flexion at ankle joint (degree) Navicular drop test (mm)

43 Results Agreement between observers (inter) > 0.80 (good) Risk classifikation Amputation Charcot deformity Foot ulcer Gait deviation Hallux valgus/hallux varus

44 Study IV Comparison of plantar pressure in three types of insole given to patients with diabetes at risk of developing foot ulcers - A two-year, randomized trial Ulla Hellstrand Tang, Roland Zügner, Vera Lisovskaja, Jon Karlsson, Kerstin Hagberg och Roy Tranberg Journal of Clinical & Translational Endocrinology, 2014.

45 Aim To compare the plantar pressure between three types om commonly used insoles.

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47 Start 35 EVA insoles (39) 55 EVA insoles (37) Prefab. insoles (38) 6 months (36) 3 (33) 4 (34) 4 12 months (31) 5 (29) 4 (33) 1 18 months (30) 1 0,9 % (28) 1 (32) 1 24 months (29) 1 (26) 2 (31) 1

48 Peak plantar pressure (kpa) Value Std. Err. DF p-value Hallux Prefabricated Diff. 35 EVA ,08 Diff. 55 EVA ,66 Age, insole ,93 Metatarsal head 1 Prefabricated Diff. 35 EVA ,05* Diff. 55 EVA ,45 Age, insole ,07 Metatarsal head 2 Prefabricated Diff. 35 EVA ,04* Diff. 55 EVA ,16 Age, insole ,58

49 Peak plantar pressure (kpa) Value Std. Err. DF p-value Metatarsal head4 Prefabricated Diff. 35 EVA Diff. 55 EVA Age, insole Metatarsal head 5 Prefabricated Diff. 35 EVA Diff. 55 EVA * Age, insole Midfoot Prefabricated Diff. 35 EVA Diff. 55 EVA Age, insole

50 Peak plantar pressure (kpa) Value Std. Err. DF p-value Heel Prefabricated Diff. 35 EVA *** Diff. 55 EVA *** Age, insole *

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52 Study Discussion + - I II III Participants no foot ulcer. Historical, new foot data. D-Foot identifies risk factors. IV 2 years follow up No barefoot measure. Lack of control group. Clinical method- not validated. Different techniques and time points. Reliability - variation Not yet included- blood circulation No barefoot measure.

53 Discussion

54 Assessments D-Foot Foto measures Conclusion Plantar pressure measurements Identifies risk factors Study of patients experience when the feet are evaluated with D-Foot. Listen to Åsa Edlunds presentation on Saturday

55 Conclusion Assistive devices For each patient: consider the individual variation Customised insoles to pressure at heel Prefabricated insole an alternative

56 D-Foot Några bilder på D-Foot Foot ulcer

57 Thanks Illustrationer: Pontus Andersson