Upload File

the challenge of diabetic foot care....‘diabetic foot ulcer’ facts… “people with diabetes...

  • Home
  • Documents
  • The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without
32
The challenge of diabetic foot care. Rachel Mathison MSc, BSc(Hons), MChS

Upload: others

Post on 14-May-2021

3 views

Category:

Documents


0 download

Report

TRANSCRIPT

Page 1: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

The challenge of diabetic foot care.

Rachel Mathison MSc, BSc(Hons), MChS

Page 2: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

The challenges…???

http://www.google.co.uk/imgres?imgurl=http://woodworkingcarpentry.info/Pictures/question clipart.gif&imgrefurl=http://woodworkingcarpentry.info/ContactUs.htm&usg=__xJaDcBl3WulLwqu18gwahPUcEJk=&h=194&w=178&sz=6&hl=en&start=4&zoom=1&tbnid=TUUBx053_mb9kM:&tbnh=103&tbnw=95&ei=ReWCTuOYKMOt8gPOr_gJ&prev=/search?q=question+clipart&hl=en&sa=X&gbv=2&tbm=isch&itbs=1
Page 3: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

Feet – aghhh.…!

Photographs reproduced with kind permission of Tess & Harvey Lewis.

Page 4: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

Photographs reproduced with kind permission of R.Mathison; Podiatrist - Stockport NHS Foundation Trust, UK.

Feet – ughhh….!

Page 5: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

Bakker K, Time to Act; Diabetes and Foot Care International Diabetes Federation, International Working Group on the Diabetic Foot. 2005 p34

“Every 30 seconds a lower limb is lost to diabetes somewhere in the world…”

In the UK: Around 5,000 people with diabetes undergo leg, foot or toe amputations each year, equivalent to 100 per week.

Page 6: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower

extremity amputation than people without diabetes.”

“Approximately 15% of all people with diabetes will have a foot ulcer at least once during their lifetime.”

“Up to 85% of all amputations begin with an ulcer.”

“Studies have shown that foot ulcers can be prevented and successfully treated. It is likely, therefore, that many amputations are also preventable.”

Bakker K, Time to Act; Diabetes and Foot Care International Diabetes Federation, International Working Group on the Diabetic Foot. 2005 p32

Page 7: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower

extremity amputation than people without diabetes.”

“Approximately 15% of all people with diabetes will have a foot ulcer at least once during their lifetime.”

“Up to 85% of all amputations begin with an ulcer.”

“Studies have shown that foot ulcers can be prevented and successfully treated. It is likely, therefore, that many amputations are also preventable.”

Bakker K, Time to Act; Diabetes and Foot Care International Diabetes Federation, International Working Group on the Diabetic Foot. 2005 p32

Page 8: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

Set the Scene… × Build on you existing skills and knowledge

× Describe a practical, structural approach based on

best evidence

Page 9: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

9

Clinical Features…..

Page 10: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

10

DIABETES

ISCHAEMIA

Microvascular (Small vessel

disease)

Macrovascular (Large vessel

disease)

Ulceration

Page 11: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

Photograph is reproduced with kind permission of E.Gibson, Tissue Viability Nurse, East Sussex NHS Trust, UK.

Ischaemia

Page 12: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

12

DIABETES

NEUROPATHY

Motor Sensory Autonomic

Dry skin Deformity

Fissures

Ulceration

Page 13: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

Neuropathy

Photographs reproduced with kind permission of R.Mathison; Podiatrist - Stockport NHS Foundation Trust, UK.

http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCJGKyIPp9scCFYZLkgodguICnQ&url=http://www.utahfootclinic.com/Puncture-Wound.php&bvm=bv.102537793,d.aWw&psig=AFQjCNHFDjYdtNrNrMmXeyPDeOAc3zcEdg&ust=1442330186312141
Page 14: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

14

DIABETES

ISCHAEMIA NEUROPATHY

Motor Sensory Autonomic

Dry skin Deformity

Fissures

Ulceration

Microvascular (Small vessel

disease)

Macrovascular (Large vessel

disease)

Ulceration

Page 15: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

Neuro-Ischaemic Foot

Photographs reproduced with kind permission of L Stuart, Consultant Podiatrist, North Manchester PCT, UK.

Page 16: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

Why is the diabetic foot vulnerable?

× Vascular disease

× Nerve damage

× Underlying susceptibility to infection

× Hyperglycaemia

Page 17: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

Foot Assessment…

Page 18: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

Assessment

1. Testing of foot sensation using 10g monofilament 2. Palpation of foot pulses 3. Inspection for any foot deformity 4. Inspection of footwear

Page 19: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

19

× Monofilament 10g

× Observation foot / toe deformities and footwear

× Palpation of foot pulses

….the ‘Mop’ test

Page 20: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

Avoid hard skin

Test 3 sites per foot

If 2 out of 3 absent, there may be sensory loss

If no monofilament, use ballpoint pen

‘M’ – Monofilament…Testing of foot sensation

Page 21: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

‘O’ – Observation…

× High arches × Clawed toes × Bunions

Will all give high

pressure / friction areas at site of ulcer

FOOTWEAR… Slip-on vs lace up. Shallow, tapered toe vs deep round toe area… Thin hard soles vs cushioned soles

Page 22: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

Feel for 2 pulses per foot If both absent there may

be ischaemia…

‘P’ – Palpation of pulses…

Monophasic

Bi-phasic

Tri-phasic

Page 23: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

23

Whether or not your patient may have… × A loss of feeling × Poor circulation × A foot shape that is causing pressure / friction areas

inside their footwear × Footwear that is causing pressure / friction against the

foot

Information you now have

Page 24: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

24

Page 25: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

Next Steps…

Page 26: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without
Page 27: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

MDT Approach….a climate that fosters collaborative care!

DN

TVN

Dietician

Patient Orthotist

Podiatrist

GP

Vasc Surgeon

Physician

DFU

Page 28: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

Management - 6 key aspects….

Multidisciplined Framework

Microbiological Control

Vascular Control

Mechanical Control

Metabolic Control

Wound Control

Educational Control

Page 29: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

The Challenge… DFU represents great challenge because: Neuropathy & lack of protective pain sensation Ischaemia Poor immune system Patients with poor eyesight

“LOCATION, location, location…..”

Page 30: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

Conclusion… Catch them early Treat Aggressively Watch out for subtle signs of infection Referral… Do it EARLY…!

Page 31: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

The Challenge….!

Page 32: The challenge of diabetic foot care....‘Diabetic Foot Ulcer’ Facts… “People with diabetes are up to 40 times more likely to undergo lower extremity amputation than people without

Diabetic Foot Australia guideline on footwear for people

Diabetic Foot Kuliah

Diabetic Foot Syndrome€¦ · Diabetic Foot Syndrome Conclusions Foot problems are a major cause of morbidity and mortality in people with diabetes. The feet of diabetic patients

“Diabetic foot”

The Diabetic foot: An i overview - Diabetic Foot Mansoura Egypt

Diabetic Foot Ulcers Diabetic Foot Ulcer Treatment and Prevention

Diabetic Foot Ulcers

Title: Osteomyelitis of the Foot in Diabetic People ...€¦ · and ulcer inflammation, ulcer size, or bone histology. of the foot ulcer. Pathological ... Diabetic ulcer severity

evaluation of foot at risk among diabetic patients using diabetic foot

Foot Diabetic

Diabetic Foot Ulcer

Diabetic Diabetic Foot UlcersDiabetic Foot Ulcersfiles.ctctcdn.com/b0923a22101/3a404655-324d-46be-9fa8-7ada48da50… · 4/1/2015 3 PrevPrevalencealence 16 16 million people in the

Inpatient management of diabetic foot problems. NICE ... diabetic foot problems 2012.pdfDiabetic foot problems Inpatient management of diabetic foot problems January 2012 The section

The Diabetic foot - Clinical Establishments · limb amputated within two years’ time. People with a history of diabetic foot ulcer have a 40% greater 10-year death rate than people

Diabetic Foot/ foot ulcer

ID of Diabetic Foot - ce.mayo.edu Diabetic Foot... · ID of Diabetic Foot . ... Diagnosing osteomyelitis in the diabetic foot Using ulcer size, ... culture but negative or absent

The Diabetic Foot - adea.com.au€¦ · The Diabetic Foot Cara Westphal Head of Dept ... Diabetic Foot Pathophysiology ... ulceration, amputation, severe PAD

Diabetic Foot TP

Diabetic Foot Infection Diabetic Foot Infections Guideline ... Final.pdf · 5 UMHS Diabetic Foot Infection 10/2019 Clinical Background A diabetic foot infection is a soft tissue or

Diabetic foot = القدم السكرية - DermaAmin · Diabetic foot = ﻢدﻘﻠا ﺔﻴرﻜﺴﻠا Causes The microbiologic features of diabetic foot infections vary according

Diabetic Foot Guide Diabetic Foot Guide - BiP Solutions Ltd

Diabetic foot disease in Indigenous people - Open …...Diabetic foot disease in Indigenous people Deborah E Schoen 1 & Paul E Norman*,2 3 1 Western Australian Centre for Rural Health,

The Diabetic foot - NHSRCqi.nhsrcindia.org/sites/default/files/The Diabetic foot_0.pdf · People with a history of diabetic foot ulcer have a 40% greater 10-year death rate than people

Diabetic Foot