diabetic foot lecture 2010

Diabetic Foot Complications –

Current treatments and

advanced therapies in treating the diabetic

footfoot

Don Pelto, DPM

Central Massachusetts Podiatry, PC

Worcester, MA

Objectives

• Participants will understand incidence and economic impact of diabetic foot infections

• Participants will define the risk factors leading to diabetic foot infections

• Participants will learn to diagnose an “at risk” • Participants will learn to diagnose an “at risk” diabetic foot

• Participants will understand current treatments and advanced therapies in the standard of care/treatment for diabetic foot ulcers

Case Study M.S.

• CC: Chronic ulceration

right foot

• PMH: DM-2, HTN,

Restless Leg SyndromeRestless Leg Syndrome

• PSH: Unremarkable

• NKDA

• Meds: Glucophage,

Humalog, Miripex,

Lisinopril

Diabetic Foot Ulcers

• One of the most common complications of diabetes

• Annual incidence 1% to 4%1-2

• Lifetime risk 15% to 25%3-4

• ~15% of diabetic foot ulcers result in lower extremity amputation3,5amputation3,5

• ~85% of lower limb amputations in patients with diabetes are preceded by ulceration6-7

• Peripheral neuropathy is a major contributing factor in diabetic foot ulcers1-7

1. Reiber and Ledoux. In The Evidence Base for Diabetes Care. Williams et al, eds. Hoboken, NJ: John Wiley & Sons; 2002:641–665.

2. Boulton et al. NEJM. 2004;351:48.3. Sanders. J Am Podiatry Med Assoc. 1994;84:322.

4. Boulton et al. Lancet. 2005;366:1719.5. Ramsey et al. Diabetes Care 1999;22:382.6. Pecoraro et al. Diabetes Care. 1990;13:513.7. Apelqvist and Larsson. Diabetes Metab Res Rev.

2000:16:S75.

Costs to Treat a Diabetic Foot Ulcer

Over a 2-Year Period Following Detection

Ramsey et al. Diabetes Care. 1999;22:382.

Cost analyses based on percent change in the medical component of the US consumer price index.

5-Year Mortality Rates

Armstrong DG, Wrobel J, Robbins JM. Guest Editorial: are diabetes-related wounds

and amputations worse than cancer? Int Wound J. 2007;4(4):286–287

The Diabetic Foot – Risk Factors

The Comprehensive

Diabetic Foot Exam

• Dermatological Considerations

• Nerve Considerations

• Osseous Considerations• Osseous Considerations

• Vascular Considerations

• Shoegear Considerations

Pinzur et al. Foot & Ankle International. 2005;26:1:113-119. Guidelines for diabetic footcare.

Valk GD, Kriegsman DMW, Assendelft WJJ. Patient education for preventing diabetic foot ulceration.

Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD001488. DOI:

10.1002/14651858.CD001488.pub2.

Current and Advanced Treatments for

Wounds

Dermatological Considerations

• Dry Skin

• Fungal Infection

• Callus

• Interdigital lesions• Interdigital lesions

• Ingrown Nail

• Ulceration

Dermatological Considerations

• Dry Skin

• Fungal Infection

• Callus

• Interdigital lesions• Interdigital lesions

• Ingrown Nail

• Ulceration

Spencer SA. Pressure relieving interventions for preventing and treating diabetic foot ulcers.

Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD002302. DOI:

10.1002/14651858.CD002302.

Dermatological Treatments

• Callus

– Diabetic shoes

• Ulceration

– VAC– VAC

– Debridement

– Dermal Skin Substitute

– Platelet Rich Plasma

Spencer SA. Pressure relieving interventions for preventing and treating diabetic foot ulcers. Cochrane Database of Systematic

Reviews 2000, Issue 3. Art. No.: CD002302. DOI: 10.1002/14651858.CD002302.


• Callus

– Diabetic shoes

• Ulceration

– VAC– VAC

– Debridement



Ubbink DT, Westerbos SJ, Evans D, Land L, Vermeulen H. Topical negative pressure for treating chronic wounds. Cochrane Database of Systematic

Reviews 2008, Issue 3. Art. No.: CD001898. DOI: 10.1002/14651858.CD001898.pub2.


• Callus

– Diabetic shoes

• Ulceration

– VAC– VAC

– Debridement



Edwards J, Stapley S. Debridement of diabetic foot ulcers. Cochrane Database of Systematic Reviews 2010, Issue 1.


• Callus

– Diabetic shoes

• Ulceration

– VAC– VAC

– Debridement



Nerve Considerations

• Neuropathy

• Semmes Weinstein 5.07

monofilament (10g)

• EMG and NCV• EMG and NCV

Nerve Treatments

• Neuropathy

– Medication Oral

– Topical Medication

– ENFB (Epidermal Nerve

Fiber Biopsy)Fiber Biopsy)

Musculoskeletal Considerations

• Foot Deformities

• Plantar Pressure

• Charcot Joint

Musculoskeletal Considerations


• Gait Evaluation

• Plantar Pressure

• Charcot Joint• Charcot Joint

Musculoskeletal Treatments


– Preventative foot

surgery

Vascular Considerations

• Pulses

• Capillary filling time

• Color changes

• Edema• Edema

• Temperature

Vascular Considerations

• Pulses

– Revascularization

– Silverhawk

– Vascular flaps

Shoegear Considerations

• Type of shoe

• Fit

• Lining Wear

• Insoles, Orthoses• Insoles, Orthoses

• Socks

Shoegear Modifications

• Diabetic extra-depth

shoes

• Diabetic socks

• Multi-density inserts• Multi-density inserts

Thank You

Don Pelto, DPM

Central Massachusetts Podiatry, PC

Worcester, MA

508.757.4003

[email protected]

diabetic foot lecture 2010

Health & Medicine