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Diabetic Foot

This document discusses diabetic foot disease and prevention of foot ulcers. It notes that every 30 minutes a limb is lost due to diabetes and every 30 seconds due to landmines. Diabetic foot is defined as a syndrome where neuropathy, angiopathy and infection lead to tissue breakdown. Management involves primary, secondary and tertiary prevention through risk factor modification, early detection, treatment and education. Cornerstones of prevention are identifying at-risk feet, regular inspection, education, appropriate footwear, and treating risk factors. Clinical evaluation assesses sepsis signs, foot examination and perfusion testing. Ulcers are classified and treated through offloading, perfusion restoration, infection treatment, and metabolic/comorbidity control with local care and

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69 views18 pages

Diabetic Foot

This document discusses diabetic foot disease and prevention of foot ulcers. It notes that every 30 minutes a limb is lost due to diabetes and every 30 seconds due to landmines. Diabetic foot is defined as a syndrome where neuropathy, angiopathy and infection lead to tissue breakdown. Management involves primary, secondary and tertiary prevention through risk factor modification, early detection, treatment and education. Cornerstones of prevention are identifying at-risk feet, regular inspection, education, appropriate footwear, and treating risk factors. Clinical evaluation assesses sepsis signs, foot examination and perfusion testing. Ulcers are classified and treated through offloading, perfusion restoration, infection treatment, and metabolic/comorbidity control with local care and

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DIABETIC

FOOT
Every 30 minutes, a limb is lost due to a
“

landmine.

Every 30 seconds, a limb is lost due to


diabetes.”

- Bahara, Mills et al. International Wound Journal 2009.


Spectrum of pathological entities that
DIABETIC affect the foot of a person with diabetes
FOOT

A syndrome in which neuropathy,


angiopathy and infection will lead to
tissue breakdown resulting in
morbidity and possible amputation
(WHO 1995)
POOR
GLYCEMIC
CONTROL
MANAGEMENT

Secondary
• Prevention Prevention • Reduce
• Modify and • Early detection complications
prevent risk • Prompt and disability
factors treatment
Primary Tertiary
Prevention Prevention
CORNERSTONES OF FOOT ULCER
PREVENTION
1 Identifying the at-risk foot.

2 Regularly inspecting and examining the at-risk foot.

3 Educating the patient, family, and health care professionals.

4 Ensuring routine wearing of appropriate footwear.

5 Treating risk factors for ulceration.


Schaper Nc, et al. Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update)
CLINICAL EVALUATION
General • Signs of sepsis
Assessment
• Temperature and color
Foot Examination
• Lesions or deformities

• Intermittent claudication

• Ankle-brachial index <0.9

Peripheral artery • Foot pulses


disease
• Duplex

• Angiography

• Pinprick │ Monofilament
Loss of protective
sensation
• Vibration │ Tuning fork
ULCER CLASSIFICATION
ULCER CLASSIFICATION
ULCER TREATMENT
Pressure offloading and ulcer protection

Restoration of tissue perfusion

Treatment of infection

Metabolic control and treatment of comorbidities

Local ulcer care

Education for patient and relatives


Schaper Nc, et al. Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update)
Pressure offloading and ulcer protection
Restoration of tissue perfusion
Treatment of infection
Metabolic control and treatment of
comorbidities
Local ulcer care
Education for patient and relatives

1) careful selection of footwear,


2) daily inspection of the feet to detect early signs of poor-fitting
footwear or minor trauma,
3) daily foot hygiene to keep the skin clean and moist,
4) avoidance of self-treatment of foot abnormalities and high-risk
behavior (e.g., walking barefoot), and
5) prompt consultation with a health-care provider if an abnormality
arises.
SIMPLE TIPS TO
PREVENT FOOT
ULCERS
REFERENCES

 Schaper NC, van Netten JJ, Apelqvist J, Bus SA, Hinchliffe RJ, Lipsky BA, IWGDF
Editorial Board. Practical Guidelines on the prevention and management of
diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev.
2020;36(S1):e3266. https://doi.org/10.1002/dmrr.3266

 Jameson, et al, (2018). Harrison’s Principles of Internal Medicine, 20 th edition

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