DIABETIC FOOT CARE

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DIABETIC FOOT CARE

• BAGIAN ILMU KEDOKTERAN FISIK DAN REHABILITASI
• RS DR. HASAN SADIKIN
• BANDUNG

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INTRODUCTION

• 15 DIABETIC PATIENTS WILL SUFFER FOOT PROBLEMS
• RISK FACTOR MAJORITY OF PATIENTS WITH TYPE 2 DM
  AND LONG STANDING TYPE 1 DM
• 45 OF ALL MAJOR AMPUTATION CAUSED BY DIABETIC
  FOOT SYNDROME

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INTRO.

• DEATH CAUSED OF FOOT DIABETIC 17-32
• GOOD DIABETIC FOOT CARE WILL DECREASE AMPUTATION
  IN ½ - ¾ CASES

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DEFINITION OF DIABETIC FOOT SYNDROME

• FOOT ABNORMALITIES CAUSED BY NEUROPATHY,
  ANGIOPATHY AND INFECTION IN DIABETES MELLITUS
  PATIENTS

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COMMON FOOT PROBLEMS
CHARCOT JOINT
HAMMER TOE
HALUX VALGUS
ULCER
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INGROWN TOENAILS
CORN CALLUS
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DM
Peripheral neuropathy
Peripheral vascular disease
Increase flow regulation
motor
sensory
Autonomic
pain ? proprioception ?
Shunting
sweat ?
Power imbalance
Reduced capillary blood flow
Fissuring ?
Deformity
Defective response to start foot ulcer and
infection
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PERUBAHAN TEKANAN PADA KAKI
MONOFILAMENT TEST
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NEUROPATI
DEEP TENDON REFLEX TEST
TUNING FORK VIBRATORY SENSE
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ANGIOPATHY

• PULSASI ARTERI DORSALIS PEDIS

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MANAGEMENT GOAL FOR DIABETIC FOOT

• ACUTE
• WOUND HEALING
• SAFE THE FOOT FROM AMPUTATION
• CHRONIC
• TO PREVENT RECURRENCY OF WOUND

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GRADING ULCER (WAGNER CLASSIFICATION)
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OBJECTIVE
LEVEL I
Neuropathy
No wound
LEVEL II
Neuropathy Deformity
Wound free
Neuropathy History of wound/amputation
Treat the wound early No recurrent wound No
amputation
LEVEL III
Neuropathy bone disorganization
LEVEL IV
Wound free No amputation
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LEVEL I
Neuropathy
Objective No wound
Intervention and plan of treatment
General foot care Appropriate foot wear
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LEVEL II
Neuropathy Deformity
OBJECTIVE WOUND FREE
Intervention and plan of treatment
Foot care Preventive surgery Protective
foot wear
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LEVEL III
Neuropathy History of wound/amputation
ObjectiveTreat wound early, no recurrent wound
no amputation
Intervention and plan of treatment
Foot care Treat the wound by off loading
Tech. Surgery (for complicated wound)
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LEVEL IV
Neuropathy Bone Disorganization
Objective Wound free No Amputation
Intervention and plan of treatment
Intensive foot care Rehabilitation a.
Conservative treatment b. Reconstructive
Surgery Protective footwear
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LONG TERM CARE

• TO PREVENT RECURRENT WOUND
• EDUCATION
• DIABETIC FOOT CARE

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DIFFERENTIATION OF THE FOOT

• DIABETIC FOOT
• Damaged Nerves ? difficult to feel pain,
  pressure, heat and cold.
• Blocked Blood Vessels bring fewer nutrients and
  oxygen to feet ? sores may not be able to heal.
• Weakened Bones may slowly shift, causing foot to
  become deformed and changing the way distributes
  pressure.
• Collapsed Joints, especially a collapsed arch,
  can no longer absorb pressure or provide
  stability. The surrounding skin may begin to
  break down.

• HEALTHY FOOT
• Nerves let you feel pain, vibration, pressure,
  heat, and cold
• Blood Vessels Carry nutrients and oxygen to your
  feet to nourish them and help them heal from
  injuries.
• Bones give your foot shape and help distribute
  the pressure from your body's weight.
• Joints are the connections between your bones.
  They help absorb pressure and allow your foot to
  move. Your arch is a group of joints that
  provides stability for you entire foot

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DIABETIC FOOT CARE
DIABETES REDUCES SENSATION WHICH CAN LEAD TO
INJURIES
Blisters or Calluses start as red or warm spots.
They are often caused by unrelieved skin pressure
Ulcers (sores) may result if blisters or calluses
reach the skin's inner layers. Ulcers may become
infected.
Bone Infection may occur if infected ulcers
spread. Untreated bone infections may lead to
loss of foot.
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DIABETIC FOOT CARE AND EDUCATION

• CHECK YOUR FEET EVERY DAY
• DO YOUR SEE RED SPOTS ?
• DO YOU HAVE BLISTERS OR CALLUSES ?

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CARE AND EDUCATION
IRRITATIONS, SKIN LESIONS
BLISTER
CUTS BETWEEN YOUR TOES
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• DO YOU FEEL TINGLING?
• ARE YOUR FEET COLD?
• ARE YOUR FEET NAILS INGROWN?
• HAS YOUR ARCH DECREASED?

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CARE AND EDUCATION

• TEST THE TEMPERATURE OF THE WATER BEFORE PUTTING
  YOUR FEET
• WASH YOUR FEET WITH LUKEWARM WATER AND MILD SOAP

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CARE AND EDUCATION

• KEEP SKIN SUPPLE MOISTURISED
• CUT YOUR NAIL CORRECTLY
• Do not cut the corner of your toe nails

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CARE AND EDUCATION

• DO NOT WALK BARE FOOT

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EXAMINE YOUR FEET DAILY

• DRY YOUR FEET PROPERLY
• DO NOT SOAK MORE THAN 5 MINUTES

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DIABETIC SHOES
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How To Select The Right Shoes?
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GOOD DIABETIC SHOES..

• Both feet measures
• Deep and wide toes box
• Flexible rubber soles
• Cushioned insole, 0.5-1 cm thick and softness

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GOOD DIABETIC SHOES..

• Deep wide enough to accommodate the foot
• A firm heel counter/Back strap
• Adjustable by laces/velcro fasteners to keep the
  shoe on the foot securely
• Acceptable to the patient in appearance, cost
  function

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TYPE OF FOOTWEAR
Custom Molded Shoes With Insoles
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TYPE OF FOOTWEAR
Molded Sandal
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WARNING SIGNS AND SYMPTOMS OF DIABETIC FOOT
PROBLEMS
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REMEMBER

• EXAMINE YOUR SHOES
• BEFORE PUTTING THEM ON
• DONT ATTEMPT SELF TREATMENT
• SEEK IMMEDIATE MEDICAL ATTENTION

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THANK YOU

• HATUR NUHUN

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Type of Footwear
Molded Insole
1. Increasing wt.bearing area 2. Assist the foot
in normal function
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Metatarsal bar
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PATOGENESIS
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DIABETIC FOOT LESION GRADING SYSTEM - WAGNER
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MANAGEMENT