Ryan Causby B.App.Sc(Pod), Grad.Dip(Pod)

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Ryan CausbyB.App.Sc(Pod), Grad.Dip(Pod)
The neuropathic foot

• Central Northern Adelaide Health Service
• University of South Australia

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Conditions causing neuropathy

• Diabetes
• Alcoholism
• Infections
• Malignancies
• Auto-immune disease
• Hereditary disorders
• Ageing process
• Trauma
• Idiopathic

medicalimages.allrefer.com/large/alcoholic-neuropa
thy
10-23, Neuropathy with no known cause.7
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Today

• Neuropathy...the stats
• Effects of Neuropathy
• Neuropathic wounds
• Management

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• 900,000 with diabetes in SA (1999)
• 47.9 Diabetics had neuropathy as a
  complication (SA)

www.dhs.sa.gov.au/pehs/cpse/diabetes_clearing_hous
e.hml
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Symptoms
90
70
Objective testing
40
Electrophysiological testing
20
No Neuropathy
0
Craig Payne, 2004, Multi-disciplinary approach to
the diabetic foot conference, Adelaide SA
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Sage, Ronald et al., Outpatient Care and
Morbidity Reducation in Diabetic Foot Ulcers
Associated with Chronic Pressure Callus Journal
of the American Podiatric Medicine Association,
Vol. 91, No. 6, June 2001
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Processes leading to Ulceration

• Loss of sensation
• Pressure
• Lack of innate nociceptive feedback
• Structural changes
• Fat Pad atrophy
• Autonomic changes
• Skin Pathology
• Proprioception
• Biomechanics
• Soft tissue glycolisation
• Charcot Foot

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Causes of Ulceration

• 67 Neuropathic
• 26 Neuro-ischaemic
• 1 Ischaemic
• 6 Unknown origin5

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Frequency of wound location

• 22 1st MPJ
• 10 Plantar Hallux4
• 20 1st MPJ
• 24 2nd MPJ
• 32 3rd MPJ6

Wound location Armstrong, et al., diabetes care,
vol. 21, no. 5 1998
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Management of Neuropathic Wounds

• Assessment
• Neuro-vasc.
• Dermatological
• Structural
• Biomechanical
• Wound management
• Referral!
• Off-loading

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Off-Loading the Diabetic Foot

• Weight Loss
• Debridement
• Footwear
• Bed rest, Crutches, Wheelchairs
• Felt/Foam Padding
• Accommodative orthoses
• Rigid sole/ Half-shoes/ Rocker-sole
• Removable Cast Walkers
• Total Contact Casts

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Off-Loading the Diabetic Foot

• Weight Loss
• Debridement
• Footwear
• Bed rest, Crutches, Wheelchairs
• Felt/Foam Padding
• Accommodative orthoses
• Rigid sole/ Half-shoes/ Rockers/ Carbon Fibre
• Removable Cast Walkers
• Total Contact Casts

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Protection (trauma infection) Swelling Immobilis
ation Costly Time Risk of iatrogenic
trauma Infection
Protection Immobilisation Check foot
regularly Dressing change COMPLIANCE
Vs
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Fleischli JG, Lavery LA, Vela SA, et al.,
Comparison of strategies to reduce pressures at
the site neuropathic ulcers. Journal of the
American Podiatric Medicine Association Vol. 87,
1997.
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Armstrong DG, Lavery LA Evidence Based options
for Off-loading diabetic wounds online,
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What else to think about

• Glycaemic control
• Vascular status
• Infection
• Weight loss
• Nutrition
• Chronic wounds
• Bacterial Burden

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Questions??..
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References

1. Australian Institute of Health and Welfare 2002.
   Diabetes Australian Facts 2002. AIHW Cat. No.
   CVD 20 (Diabetes Series no. 3). Canberra AIHW
   (www.aihw.gov.au/publications/cvd/daf02/daf02.pdf)
   
2. Scarlet JL, Blais MR (1989) Statistics on the
   Diabetic Foot Journal of the American Podiatric
   Association Vol. 79, No. 6. 1989
3. Apelqvist J, Larsson J, AgardhCD Long-term
   prognosis for diabetics with foot ulcers Journal
   of Internal Medicine Vol. 233, No. 6, June 1993
4. Armstrong DG, Lavery LA, Harkless LB Validation
   of a Diabetic Wound Classification System
   Diabetes Care Vol. 21, No. 5, May 1998
5. Boulton A., Manchester
6. Veves A, Murray HJ, Young MJ, Boulton AJM The
   risk of ulceration in diabetic patients with high
   foot pressure a prospective study Diabetologia
   Vol. 35 (1992)