Daily Foot Examination

1. Daily Foot Examination • Check For: • Blisters • Bleeding • Injury • Smell • Increased temperature at pressure point

2. Management of Neuropathic Ulcer - 1 • General measures • Specific measures

3. Management of Neuropathic Ulcer - 2 • Good glycemic control • Treatment of infections • Management of neuropathic oedema

4. Management of Neuropathic Ulcer - 3 • All ulcers irrespective of their cause will be slow to heal in presence of oedema, due impairment of local flow • Neuropathic oedema can be treated with • Diuretics • Ace inhibitors • Ephedrine ( 30 mg tds ) • D/d: hypoalbuminemia cardiac failure

5. Management of Neuropathic Ulcer - 4 • “Over 90% of predominantly neuropathic • ulcers will heal satisfactorily with • conservative measures”

6. Management of Neuropathic Ulcer - 5 • “Key to the management is the relief of • pressure that caused the initial lesion” • Pressure is off loaded most effectively by • encasing the foot in a light plaster of paris • cast. • *Total contact cast • *Removable scotch cast boot, custom made shoes etc.

7. Management of Neuropathic Ulcer - 6 • You can put almost anything on the ulcer except the patients weight – says the Australian Podiatrist

8. Foot at risk - 1 • Our job – look after “NDF at risk” • A: Preventive measures • Treatment - rapid and intensive • Rest • Off load • Antibiotics • Foot wear • Patient education

9. Foot at Risk - 2 • B. Metabolic control • Hyperglycemia • Hypertension • Hyperlipidaemia • Cessation of smoking • C. Deformity management • D. Callus management • E. Debridement and dry skin and fissure • management

10. Foot at risk - 3 • F. Mechanical control • Off load, Off load, Off load • by rest, crutches, walkers, protective shoes, heel protective pad, decrease plantar pressure by removal callus • G. The importance of callus removal in NFU • decrease plantar pressure • shows full dimension of the ulcer • deep swab possible • drainage of exudate, removal of dead tissue • H. Infection control • I. Educational control

12. Preventing Neuropathic Foot Ulcers - 1 • Regular inspection of foot - annually • Identification of high risk feet – 3 mo / 6mo • Careful choice of foot wear • Regular chiropody • Intense education

13. Preventing neuropathic foot ulcers - 2 • “As little as one hour’s education provided by the podiatrist resulted in 70% reduction in amputations over the following 2 years . as compared with a control group who did not receive the advice” • Malone IM et al 1989

14. Glycemic control and diabetic neuropathy • Diabetes control and complication trial • showed that intensive insulin therapy • reduced the incidence of appearance of • neuropathy by about 70%

15. Daily Foot Examination • Check For: • Blisters • Bleeding • Injury • Smell • Increased temperature at pressure point

16. Management of Neuropathic Ulcer - 1 • General measures • Specific measures

17. Management of Neuropathic Ulcer - 2 • Good glycemic control • Treatment of infections • Management of neuropathic oedema

18. Management of Neuropathic Ulcer - 3 • All ulcers irrespective of their cause will be slow to heal in presence of oedema, due impairment of local flow • Neuropathic oedema can be treated with • Diuretics • Ace inhibitors • Ephedrine ( 30 mg tds ) • D/d: hypoalbuminemia cardiac failure

19. Management of Neuropathic Ulcer - 4 • “Over 90% of predominantly neuropathic • ulcers will heal satisfactorily with • conservative measures”

20. Management of Neuropathic Ulcer - 5 • “Key to the management is the relief of • pressure that caused the initial lesion” • Pressure is off loaded most effectively by • encasing the foot in a light plaster of paris • cast. • *Total contact cast • *Removable scotch cast boot, custom made shoes etc.

21. Management of Neuropathic Ulcer - 6 • You can put almost anything on the ulcer except the patients weight – says the Australian Podiatrist

22. Foot at risk - 1 • Our job – look after “NDF at risk” • A: Preventive measures • Treatment - rapid and intensive • Rest • Off load • Antibiotics • Foot wear • Patient education

23. Foot at Risk - 2 • B. Metabolic control • Hyperglycemia • Hypertension • Hyperlipidaemia • Cessation of smoking • C. Deformity management • D. Callus management • E. Debridement and dry skin and fissure • management

24. Foot at risk - 3 • F. Mechanical control • Off load, Off load, Off load • by rest, crutches, walkers, protective shoes, heel protective pad, decrease plantar pressure by removal callus • G. The importance of callus removal in NFU • decrease plantar pressure • shows full dimension of the ulcer • deep swab possible • drainage of exudate, removal of dead tissue • H. Infection control • I. Educational control

26. Preventing Neuropathic Foot Ulcers - 1 • Regular inspection of foot - annually • Identification of high risk feet – 3 mo / 6mo • Careful choice of foot wear • Regular chiropody • Intense education

27. Preventing neuropathic foot ulcers - 2 • “As little as one hour’s education provided by the podiatrist resulted in 70% reduction in amputations over the following 2 years . as compared with a control group who did not receive the advice” • Malone IM et al 1989

28. Management involves • Bed rest • Pressure offloading • Reduction of edema • Glycemic control • Most important step is the early detection • of a high risk foot by simple tests / few • quantitative tests