The Diabetic foot. diabetic. foot. the

Transcription

1 The Diabetic

2 Some basic facts. Diabetes is on increase. Foot ulcers occur in 12% to 25% of people with diabetes. Diabetics who have had a ulcer are more likely to have a re occurrence.

3 Diabetes is biggest risk factor for nontraumatic amputations. 5-year mortality rate ranges from 39% to 68% post amputation. Has significant social and economic impact.

4 What podiatrists teach Diabetes is serious At greater risk of nerve damage vascular disease wounds infection Goal is Prevention/Education.

5 Any loss of feeling in feet. Important to get a good history form client Duration of Diabetes. Or risk factors. How it is managed. Any past or present issues/changes. Any past ulcers, infections amputations. Any signs of vascular disease intermittent claudication.

6 Assessment of is important Establishes a baseline of information. Evaluates risk factors. Allows for education. Recommendations for care developed. Information recorded.

7 RISK FACTORS Neuropathy Peripheral vascular disease Ulcers Infection

8 NEUROPATHY Loss of protective sensation at greater risk if injury/trauma. sensory neuropathy. motor neuropathy. autonomic neuropathy. structural changes.

9 THE DIABETIC FOOT

10 10g semmes-weinstein monofilament tests large sensory nerve fibres, locations on are indicated below. Place monofilament on ses areas applying enough pressure for wire to bend and ask your patient to say yes or no if y feel it, and if yes where y feel it on.

11 Test each site 3 times If 3 or more areas are not detected by client is classified as Neuropathy being present.

12 Vibration testing 128Hz tuning fork Testing over bony prominences

13 THE DIABETIC FOOT

14 PERIPHERIAL VASCULAR DISEASE (PVD) Diabetics at greater risk More rapid development of vascular disease. Decreases oxygen and nutrients to tissues. Pulses become weaker. Skin is more fragile and prone to damage. Feet are cooler to touch. Poor healing and prone to infection.

15 Can you feel a pulse? (strong or weak). SVPFT less than 5 sec? refer on for furr vascular evaluation if unable to palpate pulses or appears poorly perfused. Dorsalis Pedis Pulse tibial posterior pulse

16 THE DIABETIC FOOT

17 Check dorsalis pedis and tibial pulses. Assess as 0= absent 1= present 2=normal 3=bounding pulse abnormal

18 ULCERS There are various causes of ulceration. Need to assess and treat underlying cause. Can involve long term management. Can become secondarily infected. May need referral to clinic.

19 Assess wound. Remove any non viable tissue(callus, necrotic tissue, fibrous tissue, etc.) Clean wound. Select appropriate wound dressing. Off load.

20 Swab for infection/or any active signs of infection. Probe wound as to depth and if bone involved. Regular review and wound dressings.

21 THE DIABETIC FOOT

22 THE DIABETIC FOOT

23 THE DIABETIC FOOT

24 INFECTION Impaired immunity. High BGL s. Osteomyelitis possible if ulcer probes down to bone. Precursor to amputation? Client may feel unwell flu like symptoms. Clean wound/wound care. Take a swab and send off.

25 Offload area as required. Refer as urgent to doctor or multidisciplinary care team.

26 THE DIABETIC FOOT

27 THE DIABETIC FOOT

28 Key points Diabetes does put client at greater risk of complications. evidence shows that risks factors can be managed with regular assessment, education, early intervention and treatment. (D Armstrong et al) The key is assessment and early intervention.

29 Once assessment has been done and data recorded can n assess risk category/stratification of client. Dependant upon information collected. Assessment should be done at least every 12 months.

30 Risk stratification

31 THE DIABETIC FOOT

32 REFRENCES 002/ x150.jpg wingwitt%20feet%2037%20bv2_ JoyPage/Exercise.gif images/anatomy3.jpg Primary%20School/...