Diabetic Foot Pathophysiology. Professor Donald G. MacLellan Executive Director Health Education & Management Innovations

Size: px
Start display at page:

Download "Diabetic Foot Pathophysiology. Professor Donald G. MacLellan Executive Director Health Education & Management Innovations"

Transcription

1 Diabetic Foot Pathophysiology Professor Donald G. MacLellan Executive Director Health Education & Management Innovations

2

3

4 AGEs & RAGEs in Diabetes AGE levels increased & RAGEs highly expressed in diabetic complications AGEs activate RAGE expression AGEs & RAGEs responsible for inflammatory & oxidative stress responses Circulating soluble RAGE (srage) and endogenous secretory RAGE (esrage) can counteract damaging effects of RAGE

5 AGEs & RAGEs in Diabetes Inhibiting AGEs can reduce complications such as Peripheral Neuropathy srage & esrage have protective effects Some nutrients have an affect on AGE/RAGE Worsening fructose corn syrup, refined carbs, high temp cooking Helping boiling, low temp cooking, marinating meats (red wine & herbs) Also supplements with Carnosine, Guava, Yerba mate, Lipoic acid

6

7 Diabetic Foot Ulceration Diabetic pathophysiology affects - Nerves Microvasculature Small foot muscles

8 Diabetic Foot Ulceration Nerves: Vasa Nervorum diseased Peripheral sensation diminished Vasomotor neuropathy Diminished sweating dry skin, dystrophic nails

9

10 Diabetic Foot Ulceration Microvasculature: Abnormal endothelial function Thickened BM & capillary wall fragility Vasomotor Neuropathy - loss of fine vasomotor control of the pedal circulation Arterio-venous shunting Reduced art. distribution to areas of need Resultant tissue ischaemia (despite palpable pedal pulses and distended veins)

11 Diabetic Foot Ulceration Small foot muscles: Altered innervation of the small muscles of the foot Altered distribution of forces during walking Thickened Plantar Aponeurosis & Claw foot

12 Foot deformities. Andrew J.M. Boulton et al. Dia Care 2008;31: by American Diabetes Association

13

14 Tendon Pathology DIABETES OBESITY Hypercholesterolaemia Hypercholesterolaemia Hyperuricaemia AGEs & RAGEs Cholesterol Deposits Uric Acid Deposition Adipokines Low Grade Inflammation TENDON DAMAGE

15 Diabetes and Infection

16 Risk Factors for Ulceration Previous amputation Past foot ulcer history Peripheral neuropathy Foot deformity Peripheral vascular disease Visual impairment Diabetic nephropathy (esp. patients on dialysis) Poor glycemic control Cigarette smoking

17

18 Diabetic Foot Examination Inspection skin status: colour, thickness, dryness, cracking sweating infection: check between toes for fungal infection ulceration calluses/blistering: haemorrhage into callus?

19 Diabetic Foot Examination Musculoskeletal: deformity, e.g., claw toes, prominent metatarsal heads, Charcot joint muscle wasting (guttering between metatarsals)

20 Diabetic Foot Examination Neurological assessment: 10-g monofilament + 1 of the following 4 vibration using 128-Hz tuning fork pinprick sensation ankle reflexes vibration perception threshold

21 Upper panel: For performance of the 10-g monofilament test, the device is placed perpendicular to the skin, with pressure applied until the monofilament buckles. Andrew J.M. Boulton et al. Dia Care 2008;31: by American Diabetes Association

22 Diabetic Foot Examination Vascular assessment: General art exam foot pulses ABI, if indicated perfusion assessment, if indicated eg. Toe Pressure, Transcut Oxygen Tension

23 Arterial Insufficiency Ulcers Treat the Cause Vascular assessment is e.g. sequential Doppler Revascularization is the key to treatment where possible Angioplasty Stents Bypass (Vascular grafts, synthetic) Medical Management ABCs Hgb A1C, BP, Cholesterol Graduated exercise program Stop Smoking Every cigarette will decrease the circulation in the leg or foot up to 30% for an hour. Smoking interferes with healing Stimulates atherosclerosis Second hand smoking is harmful Drugs? Dalteparin (Fragmin) Anti-platelet drugs Pentoxifylline?

24 Osteomyelitis: Infection Infection: If an ulcer probes to bone, there is a high incidence of Osteomyelitis Grayson et al, 1994 Lavery et al Sensitivity: 66% 87% Specificity: 85% 91% + pred. value 89% 57-62% X-rays may be less reliable

25 Diabetic Foot Ulceration Principles of management: Treat any infection Check if ischaemia can be revascularised Keep forces on ulcered area to a minimum Improve wound /ulcer bed by debridement, callus removal & topical applications Prevent ulcer recurrence

The 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 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 information

The Diabetic Foot Latest Statistics

The 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 information

VASCULAR WOUNDS PATHOPHYSIOLOGY AND MANAGEMENT

VASCULAR WOUNDS PATHOPHYSIOLOGY AND MANAGEMENT VASCULAR WOUNDS PATHOPHYSIOLOGY AND MANAGEMENT Lucy Stopher, A/CNS Vascular Surgery ...it is best to think of a wound not as a disease, but rather as a manifestation of disease. Joe McCulloch In order

More information

Peripheral Neuropathy

Peripheral 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 information

High 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 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 information

AWMA 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) 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 information

Definitions and criteria

Definitions 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 information

Introduction. Epidemiology Pathophysiology Classification Treatment

Introduction. 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 information

How can DIABETES affect my FEET? Emma Howard Specialist Podiatrist and Team Leader, Oxford Health NHS Foundation Trust

How 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 information

Preventing Foot Ulcers in the Neuropathic Diabetic Foot. Glossary of Terms

Preventing 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 information

Diabetes Mellitus and the Associated Complications

Diabetes 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 information

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 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 information

Clinical assessment of diabetic foot in 5 minutes

Clinical 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 information

AGONY FEET. The. of the. Prevention and management of diabetic foot ulcers

AGONY 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 information

EDUCATION. Peripheral Artery Disease

EDUCATION. Peripheral Artery Disease EDUCATION Peripheral Artery Disease Peripheral Artery Disease You may have circulation problems that have to do with your blood vessels. You may feel aches, pains, cramps, numbness or muscle fatigue when

More information

PUT YOUR BEST FOOT FORWARD

PUT YOUR BEST FOOT FORWARD PUT YOUR BEST FOOT FORWARD Bala Ramanan, MBBS 1 st year vascular surgery fellow Introduction The epidemic of diabetes and ageing of our population ensures critical limb ischemia will continue to grow.

More information

ULCERS 1/12/ million diabetics in the US (2012) Reamputation Rate 26.7% at 1 year 48.3% at 3 years 60.7% at 5 years

ULCERS 1/12/ million diabetics in the US (2012) Reamputation Rate 26.7% at 1 year 48.3% at 3 years 60.7% at 5 years Jay Christensen D.P.M Advanced Foot and Ankle of Wisconsin 2-4% of the population at any given time will have ulcers 0.06-0.20% of the total population Average age of patients 70 years increased as more

More information

The Diabetic Foot. Michael Anthony, DPM. 422 million diabetic million % adult population 90% Type II

The 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 information

The Diabetic Foot. Prevalence of Diabetes United States. Prevalence of Diabetes

The 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 information

Diabetic Foot Services. Ketan Dhatariya Elsie Bertram Diabetes Centre Norfolk & Norwich University Hospital

Diabetic Foot Services. Ketan Dhatariya Elsie Bertram Diabetes Centre Norfolk & Norwich University Hospital Diabetic Foot Services Ketan Dhatariya Elsie Bertram Diabetes Centre Norfolk & Norwich University Hospital Objectives 1. Background 2. Foot Screening 3. First line management ulceration 4. Management

More information

Diabetic Feet. Juanita Muller

Diabetic 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 information

Rapid Foot Screening

Rapid 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 information

Foot 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 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 information

Role of ABI in Detecting and Quantifying Peripheral Arterial Disease

Role 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 information

University of Huddersfield Repository

University of Huddersfield Repository University of Huddersfield Repository Newton, Veronica and Roberts, Peter Foot Inspection or Foot Assessment? Original Citation Newton, Veronica and Roberts, Peter (2011) Foot Inspection or Foot Assessment?

More information

DON T LET LEG PAIN BECOME A REAL THREAT.

DON T LET LEG PAIN BECOME A REAL THREAT. DON T LET LEG PAIN BECOME A REAL THREAT. These three words have the power to change lives. Between 8 to 10 million Americans are estimated to suffer from poor blood flow to the legs and feet potentially

More information

1 of :19

1 of :19 1 of 8 3-12-2012 12:19 Diabetic foot ulcer classification system for research purposes Introduction Aims of the ulcer research classification system Definitions and categorisation for the ulcer research

More information

Diabetic/Neuropathic Foot Ulcer Assessment Guide South West Regional Wound Care Program Last Updated June 10,

Diabetic/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 information

Diabetic Foot Complications

Diabetic 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 information

Wound Classification. Overview

Wound Classification. Overview Overview Jeffrey A. Niezgoda, MD FACHM, MAPWCA, CHWS Review of Initial Wound Care Consultation Rational for Classification Wound Appearance Wound Etiology Management Algorithms Initial Wound Care Consult

More information

10/19/2017. Shawn M Sanicola DPM, FACFAS Foot And Ankle Associates of WI. Consultant with J&J-Depuy-Synthesis

10/19/2017. 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 information

Is Neuropathy the root of all evil in the diabetic foot?

Is 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 information

Lower Extremity Arterial Disease

Lower Extremity Arterial Disease Lower Extremity Arterial Disease Circulating the Facts About Peripheral Disease Brought to you by the Education Committee of the Society for 1 www.svnnet.org Peripheral Artery Disease (PAD) Many people

More information

Screening for diabetic foot complications

Screening for diabetic foot complications Screening for diabetic foot complications Classifying risk of ulceration 4 Normal sensation, palpable pulses, no deformity Evidence of neuropathy, absence of pedal pulse(s) Evidence of neuropathy, absence

More information

Model of Care for the Diabetic Foot

Model 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 information

I have no financial interests to disclose in regards to this lecture.

I have no financial interests to disclose in regards to this lecture. Evaluation and Treatment of Diabetic Foot Ulcerations John M. Giurini, D.P.M. Associate Professor in Surgery Harvard Medical School Disclosure Statement I have no financial interests to disclose in regards

More information

Service Development Tool for the Assessment of Provision of Services for Patients with Diabetes Related Foot Problems

Service 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 information

2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process

2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process Quality ID #126 (NQF 0417): Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy Neurological Evaluation National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS FOR INDIVIDUAL

More information

DIABETIC 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 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 information

DIABETIC FOOT BOOK THE. A guide to keeping it simple and preventing complications. Practice genii. the Diabetic Foot Book

DIABETIC 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 information

Helen Gelly, MD, FUHM, FCCWS

Helen 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 information

Steven Hadesman, MD Chief Medical Officer, MeridianRx Internal Medicine Physician, St. John Hospital

Steven Hadesman, MD Chief Medical Officer, MeridianRx Internal Medicine Physician, St. John Hospital Steven Hadesman, MD Chief Medical Officer, MeridianRx Internal Medicine Physician, St. John Hospital Deep Venous Thrombosis Varicose Veins Venous insufficiency Phlebitis Lymphedema Elephantiasis nostras

More information

The Diabetic foot. diabetic. foot. the

The Diabetic foot. diabetic. foot. the The Diabetic 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. Diabetes is biggest

More information

Wound Jeopardy: Name That Wound Session 142 Saturday, September 10 th 2011

Wound Jeopardy: Name That Wound Session 142 Saturday, September 10 th 2011 Initial Wound Care Consult History Physical Examination Detailed examination of the wound Photographs Cultures Procedures TCOM ABI Debridement Management Decisions A Detailed History and Physical (wound)

More information

Renal Foot Care. Christian Pankhurst

Renal 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 information

A new classification of the diabetic ischaemic foot promotes a modern approach to treatment. Michael Edmonds King s College Hospital London

A new classification of the diabetic ischaemic foot promotes a modern approach to treatment. Michael Edmonds King s College Hospital London A new classification of the diabetic ischaemic foot promotes a modern approach to treatment Michael Edmonds King s College Hospital London Disclosure Speaker name: Michael Edmonds... I have the following

More information

VASCULAR DISEASE: THREE THINGS YOU SHOULD KNOW JAMES A.M. SMITH, D.O. KANSAS VASCULAR MEDICINE, P.A. WICHITA, KANSAS

VASCULAR DISEASE: THREE THINGS YOU SHOULD KNOW JAMES A.M. SMITH, D.O. KANSAS VASCULAR MEDICINE, P.A. WICHITA, KANSAS VASCULAR DISEASE: THREE THINGS YOU SHOULD KNOW JAMES A.M. SMITH, D.O. KANSAS VASCULAR MEDICINE, P.A. WICHITA, KANSAS KANSAS ASSOCIATION OF OSTEOPATHIC MEDICINE ANNUAL CME CONVENTION APRIL 13, 2018 THREE

More information

Vascular dysfunction and vulnerable skin

Vascular dysfunction and vulnerable skin Vascular dysfunction and vulnerable skin Professor Peter Vowden Honorary Consultant Vascular Surgeon Clinical Director WoundTec HTC Bradford, UK 1 Exploring the clinical problem associated with the application

More information

Rapid Recovery Hyperbarics 9439 Archibald Ave. Suite 104 Rancho Cucamonga CA,

Rapid 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 information

Practical Point in Holistic Diabetic Foot Care 3 March 2016

Practical 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 information

Practical guidelines on the management and prevention of the diabetic foot 2011

Practical 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 information

Comprehensive Diabetic Foot Exam, WorryFree DME SM Shoe Order Form

Comprehensive Diabetic Foot Exam, WorryFree DME SM Shoe Order Form Comprehensive Diabetic Foot Exam, WorryFree DME SM Shoe Order Form First perform CDFE, then use WorryFree DME! Perform CDFE on 50% or more of patients with Medicare and diabetes and qualify for PQRS end

More information

Diabetic Foot Problems

Diabetic 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 information

Appendix D: Leg Ulcer Assessment Form

Appendix D: Leg Ulcer Assessment Form Nursing Best Practice Guideline Appendix D: Ulcer Assessment Form Person Completing Assessment: Date: Client Name: Caf # CM# VON ID #: District CCAC ID # Address Telephone Home: Work: Date of Birth Y/M/D:

More information

THE FORGOTTEN COMPLICATION M. Pfeifer

THE FORGOTTEN COMPLICATION M. Pfeifer Diabetic Neuropathy THE FORGOTTEN COMPLICATION M. Pfeifer P 1 The Burden of Diabetic Peripheral Neuropathy Most common peripheral neuropathy in the developed nations Major contributor to the hospital rate

More information

Introduction to feet and ageing. Dr Debbie Turner Arthritis Research UK Senior Lecturer in Podiatry Glasgow Caledonian University

Introduction to feet and ageing. Dr Debbie Turner Arthritis Research UK Senior Lecturer in Podiatry Glasgow Caledonian University Introduction to feet and ageing Dr Debbie Turner Arthritis Research UK Senior Lecturer in Podiatry Glasgow Caledonian University Looking after your feet to reduce your risk of falling - Webinar 25 th June

More information

Disclosures. Critical Limb Ischemia. Vascular Testing in the CLI Patient. Vascular Testing in Critical Limb Ischemia UCSF Vascular Symposium

Disclosures. Critical Limb Ischemia. Vascular Testing in the CLI Patient. Vascular Testing in Critical Limb Ischemia UCSF Vascular Symposium Disclosures Vascular Testing in the CLI Patient None 2015 UCSF Vascular Symposium Warren Gasper, MD Assistant Professor of Surgery UCSF Division of Vascular Surgery Critical Limb Ischemia Chronic Limb

More information

Aetiology Macroangiopathy occurs mainly distally ie Popliteal artery There is arterial wall calcification Microangiopathy is less common

Aetiology 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 information

AIM OF MASTERCLASS. Overview of the diabetic foot disease. Modern approach to management

AIM OF MASTERCLASS. Overview of the diabetic foot disease. Modern approach to management AIM OF MASTERCLASS Overview of the diabetic foot disease Modern approach to management DIABETIC FOOT DISEASE THROUGHOUT THE WORLD, THERE IS AN AMPUTATION EVERY 20 SECONDS MOST OF THESE AMPUTATIONS ARE

More information

Chapter 36 & 37. Types of wounds. Skin Tear

Chapter 36 & 37. Types of wounds. Skin Tear Chapter 36 & 37 Wound Care and Pressure Ulcers Types of wounds A wound is a break in the skin d/t trauma, surgical incision, pressure sore, circulatory ulcers Abrasion, Contusion, Incision, Laceration,

More information

Root Cause Analysis The Tools. Angie Abbott Head of Podiatry and Orthotics Torbay and Southern Devon

Root Cause Analysis The Tools. Angie Abbott Head of Podiatry and Orthotics Torbay and Southern Devon Root Cause Analysis The Tools Angie Abbott Head of Podiatry and Orthotics Torbay and Southern Devon Why do RCA s? To understand if the amputation was avoidable or unavoidable Learn and improve Identify

More information

Keeping the diabetic foot healed How effective is the Newcastle Foot Protection Team?

Keeping the diabetic foot healed How effective is the Newcastle Foot Protection Team? Keeping the diabetic foot healed How effective is the Newcastle Foot Protection Team? Linda Robertshaw Advanced Podiatrist Nicola Coates Principal Podiatrist (Diabetes) Background Risk factors for diabetic

More information

Peripheral Arterial Disease. Westley Smith MD Vascular Fellow

Peripheral Arterial Disease. Westley Smith MD Vascular Fellow Peripheral Arterial Disease Westley Smith MD Vascular Fellow Background (per 10,000) Goodney P, et al. Regional intensity of vascular care and lower extremity amputation rates. JVS. 2013; 6: 1471-1480.

More information

Learning About. Peripheral Artery Disease

Learning About. Peripheral Artery Disease SM A C P S P E C I A L R E P O R T Learning About Peripheral Artery Disease What Is Peripheral Artery Disease? Peripheral artery disease (PAD) is a form of atherosclerosis the hardening and narrowing of

More information

Due to Perimed s commitment to continuous improvement of our products, all specifications are subject to change without notice.

Due to Perimed s commitment to continuous improvement of our products, all specifications are subject to change without notice. A summary Disclaimer The information contained in this document is intended to provide general information only. It is not intended to be, nor does it constitute, medical advice. Under no circumstances

More information

Learning Objectives for Rotations in Vascular Surgery Year 3 Basic Clerkship

Learning Objectives for Rotations in Vascular Surgery Year 3 Basic Clerkship Learning Objectives for Rotations in Vascular Surgery Year 3 Basic Clerkship CLINICAL PROBLEMS IN VASCULAR SURGERY 1. ABDOMINAL AORTIC ANEURYSM A 70 year old man presents in the emergency department with

More information

Our Vision NADA BoD Strategic Planning Session -

Our Vision NADA BoD Strategic Planning Session - Who we are NADA is a not-for-profit members-led organization established in 1995 as a result of the rising rates of diabetes among First Nations, Inuit and Métis Peoples in Canada Our Vision - 2016 NADA

More information

Diabetic Foot Ulcer Treatment and Prevention

Diabetic 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 information

Diabetic/Neuropathic Foot Ulcer Assessment Guide South West Regional Wound Care Program Last Updated April 7,

Diabetic/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 information

Practical Point in Diabetic Foot Care 3-4 July 2017

Practical 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 information

Introduction. Risk factors of PVD 5/8/2017

Introduction. Risk factors of PVD 5/8/2017 PATHOPHYSIOLOGY AND CLINICAL FEATURES OF PERIPHERAL VASCULAR DISEASE Dr. Muhamad Zabidi Ahmad Radiologist and Section Chief, Radiology, Oncology and Nuclear Medicine Section, Advanced Medical and Dental

More information

When Routine Care is Not Routine. David M Davidson, DPM Desert Foot 2014

When Routine Care is Not Routine. David M Davidson, DPM Desert Foot 2014 When Routine Care is Not Routine David M Davidson, DPM Desert Foot 2014 Disclosure: Speakers Bureau for: Integra KCI Organogenesis Smith & Nephew Vilex Epidemiology of the Diabetic Foot A lower extremity

More information

****Note: This policy does NOT address the pharmacologic treatment of mycotic nails.**** Proprietary Information of Excellus Health Plan, Inc.

****Note: This policy does NOT address the pharmacologic treatment of mycotic nails.**** Proprietary Information of Excellus Health Plan, Inc. MEDICAL POLICY SUBJECT: FOOT CARE and TREATMENT OF PAGE: 1 OF: 6 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product, including

More information

Diabetes Foot and Skin Care. Diabetes and the feet. Foot problems: Major cause of morbidity and mortality

Diabetes 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 information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE QUALITY AND OUTCOMES FRAMEWORK (QOF) INDICATOR DEVELOPMENT PROGRAMME QOF indicator area: Diabetes Briefing paper Potential output: Recommendations

More information

Please print clearly; illegible forms will delay your receiving credit/verification: City State ZIP. Yes No

Please print clearly; illegible forms will delay your receiving credit/verification: City State ZIP. Yes No PARTICIPANT INFORMATION Please print clearly; illegible forms will delay your receiving credit/verification: First Name MI Last Name Address 1 Address 2 City State ZIP Country Daytime Telephone Fax E-mail

More information

DIABETES AND FOOTCARE

DIABETES 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 information

National Aboriginal Diabetes Association

National 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 information

My Diabetic Patient Has No Pulses; What Should I Do?

My 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 information

Limb Salvage in Diabetic Ischemic Foot. Kritaya Kritayakirana, MD, FACS Assistant Professor Chulalongkorn University April 30, 2017

Limb Salvage in Diabetic Ischemic Foot. Kritaya Kritayakirana, MD, FACS Assistant Professor Chulalongkorn University April 30, 2017 Limb Salvage in Diabetic Ischemic Foot Kritaya Kritayakirana, MD, FACS Assistant Professor Chulalongkorn University April 30, 2017 Case Male 67 years old Underlying DM, HTN, TVD Present with gangrene

More information

10/9/2015. Differential Assessment of Lower Extremity Wounds. Disclosure Statement. Program Objectives

10/9/2015. Differential Assessment of Lower Extremity Wounds. Disclosure Statement. Program Objectives 3M 2015. All Rights Reserved 3M 2015. All Rights Reserved 2 3M 2015. All Rights Reserved 3 Differential Assessment of Lower Extremity Wounds Presented by: Lynn Peterson RN, BSN, CWOCN 3M Health Care November

More information

Global Peripheral Artery Disease Market: Trends & Opportunities ( ) February 2016

Global Peripheral Artery Disease Market: Trends & Opportunities ( ) February 2016 Global Peripheral Artery Disease Market: Trends & Opportunities (2015-2020) February 2016 Global Peripheral Artery Disease Market Report Scope of the Report This report entitled Global Peripheral Artery

More information

Peripheral Arterial Disease

Peripheral Arterial Disease UFS Peripheral Arterial Disease A problem of supply and demand Larry Rhoads, Associate Chief Underwriter November 8, 2011 PAD Two categories of these circulation disorders: Functional peripheral vascular

More information

Combat Extremity Vascular Trauma

Combat Extremity Vascular Trauma Combat Extremity Vascular Trauma Training teams to be a TEAM Chatt A. Johnson LTC, MC, USA 08 March 2010 US Army Trauma Training Center Core Discussion Series Outline: Combat Vascular Injury Physiologic

More information

UC SF. Disclosures. Vascular Assessment of the Diabetic Foot. What are the best predictors of wound healing? None. Non-Invasive Vascular Studies

UC SF. Disclosures. Vascular Assessment of the Diabetic Foot. What are the best predictors of wound healing? None. Non-Invasive Vascular Studies Disclosures Vascular Assessment of the Diabetic Foot What are the best predictors of wound healing? None Shant Vartanian MD Assistant Professor of Vascular Surgery UCSF Vascular Symposium April 20, 2013

More information

Diabetes - Foot Care

Diabetes - 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 information

Diabetes Foot Care: Saving Limbs, Saving Lives

Diabetes Foot Care: Saving Limbs, Saving Lives Diabetes Foot Care: Saving Limbs, Saving Lives James Elliott National Indigenous Diabetes Prevention Conference Thunder Bay September 27 th 2016 About Me Researcher / advocate Trustee for T1Internati Consultant

More information

Podiatric Medicine: Best Foot Forward. Dr. Kevin J. DeAngelis, DPM Brandywine Family Foot Care 213 Reeceville Rd. Suite 13 Coatesville, PA

Podiatric Medicine: Best Foot Forward. Dr. Kevin J. DeAngelis, DPM Brandywine Family Foot Care 213 Reeceville Rd. Suite 13 Coatesville, PA Podiatric Medicine: Best Foot Forward Dr. Kevin J. DeAngelis, DPM Brandywine Family Foot Care 213 Reeceville Rd. Suite 13 Coatesville, PA What is a Podiatrist? Specially trained physician specializing

More information

Sores That Will Not Heal

Sores That Will Not Heal Sores That Will Not Heal Introduction Some sores have trouble healing on their own. Sores that will not heal are a common problem. Open sores that will not heal are also known as wounds or skin ulcers.

More information

Independent evaluation of BEMER physical vascular regulation therapy

Independent evaluation of BEMER physical vascular regulation therapy of BEMER Liezl Naudé Advanced nurse specialist: wound management Advanced lower limb and wound management centre, Pretoria Heart 4 the Wounded 5-7 July Pretoria Introduction Lower limb wounds have always

More information

Surgical Options for revascularisation P E T E R S U B R A M A N I A M

Surgical Options for revascularisation P E T E R S U B R A M A N I A M Surgical Options for revascularisation P E T E R S U B R A M A N I A M The goal Treat pain Heal ulcer Preserve limb Preserve life The options Conservative Endovascular Surgical bypass Primary amputation

More information

Will it heal? How to assess the probability of wound healing

Will 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 information

Peripheral Arterial Disease (PAD): Presentation, Diagnosis, and Treatment

Peripheral Arterial Disease (PAD): Presentation, Diagnosis, and Treatment Peripheral Arterial Disease (PAD): Presentation, Diagnosis, and Treatment Prepared and Presented by Jon Manocchio, Pharm D Blanchard Valley Hospital October 2011 Introduction PAD is a condition that is

More information

Leg ulcer assessment and management

Leg ulcer assessment and management Leg ulceration The views expressed in this presentation are solely those of the presenter and do not necessarily represent the views of Smith & Nephew. Smith & Nephew does not guarantee the accuracy or

More information

Model of care for the diabetic foot

Model 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 information

I also call this lecture

I 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 information

The signs and symptoms of diabetic neuropathy vary, depending on the type of neuropathy and which nerves are affected.

The signs and symptoms of diabetic neuropathy vary, depending on the type of neuropathy and which nerves are affected. DIABETIC NEUROPATHY Overview Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar (glucose) can injure nerve fibers throughout your body, but diabetic neuropathy

More information

Surgical Off-loading. Reiber et al Goals of Diabetic Foot Surgery 4/28/2012. The most common causal pathway to a diabetic foot ulceration

Surgical 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 information

CHAPTER.7 CARING THE DIABETIC FOOT

CHAPTER.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 information