WORLD DIABETES DAY 16TH NOVEMBER 2011

WORLD DIABETES DAY 16TH NOVEMBER 2011 PowerPoint PPT Presentation


  • 136 Views
  • Uploaded on
  • Presentation posted in: General

PODIATRY AND FOOT ULCER PREVENTION. KEYWORDS:ORGANIZATIONEXAMINATIONEDUCATIONTREATMENTFOLLOW-UP. FEDERATION INTERNATIONALE DES PODOLOGUES. AUSTRTALIA,BELGIUM, CANADACYPRUS,CZECH,FINLAND,FRANCE,GERMANY,GREECE,HONG KONG,ICELAND,IRE-LAND,ISRAEL,ITALY,MALTA,MAROCCO,NEW ZEALAND,NORWAY,PERU,P

Download Presentation

WORLD DIABETES DAY 16TH NOVEMBER 2011

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


1. WORLD DIABETES DAY 16TH NOVEMBER 2011 KOCAELI UNIVERSITY KIRSTEN LARSEN COPENHAGEN

2. PODIATRY AND FOOT ULCER PREVENTION KEYWORDS: ORGANIZATION EXAMINATION EDUCATION TREATMENT FOLLOW-UP

3. FEDERATION INTERNATIONALE DES PODOLOGUES AUSTRTALIA,BELGIUM, CANADA CYPRUS,CZECH,FINLAND, FRANCE,GERMANY,GREECE, HONG KONG,ICELAND,IRE- LAND,ISRAEL,ITALY,MALTA, MAROCCO,NEW ZEALAND, NORWAY,PERU,PORTUGAL,SPAIN, SOUTH AFRICA,SWEDEN, SWITZERLAND,THE NETHER- LANDS,GREAT BRITAIN, AMERICA, URUGUAYA

4. FIP CO-WORK WITH WHO WORLD CONGRESS EVERY 3 YEARS QUARTERLY MAGAZIN: ” FOOTSTEPS” INTERN.EDUCATION AND RESEARCH SUBCOMMITTEE ACADEMY OF PODIATRIC MEDICINE ESPECIALLY for DIABETES MELLITUS

5. PODIATRY EDUCATION DENMARK: 18 MONTHS 30 HOURS/WEEK 40% THEORETICAL, 60% CLINIC AND HOSPITAL-TRAINING + WORKWHOP(INSOLES AND ORTHOTICS) 2 STATE-SUPPORTED SCHOOLS, 150/YEAR EDUCATION: FREE OF COSTS MOST STUDENTS ARE FORMER HEALTH CARE PROFESSIONALS, SOME FEW DIRECTLY FROM HIGH SCHOOL OR OTHER PROFESSIONS

6. CONTENT OF EDUCATION ANATOMY,FYSIOLOGY,INFECTIONS- PATHOLOGY,MICROBIOLOGY, ORTO- PEDY,DERMATOLOGY,PSYCOLOGY, HEALTH-PAEDAGOGIC,TREATMENT- PRINCIPLES,DOCUMENTATION, TREATMENT OF NORMAL/ABNORMAL SKIN/NAILS, NAILBRACES, INSOLES AND ORTHOTICS

7. STATE-AUTORIZATION AFTER EXAM POSSIBILITY FOR CONTRACT WITH NATIONAL HEALTH SYSTEM INSURANCE LIKE OTHER HEALTH PROFESSIONALS POST-GRADUATE COURSES WITH HEALTH CARE PROF.AND OUR ASSOCIASTION

8. THE GOAL ABLE TO DIAGNOSE DISEASES IN THE FOOT/LEG, EDUCATE THE PTT. IN SELFCARE, NON-INVASIVE TREAT- MENT, PROTECTION OF PRESSURE POINTS. IN DIABETIC FOOTULCERS DEBRIDE AND PROTECT ULCERZONE , CORRECT DEFORMITIES BY INSOLES AND SILICONE-ORTHOSES CORRECT INGROWN NAILS BY NAIL-BRACES.

9. THE MULTIDISCIPLINARY IWGDF ORGANIZING AND PUBLISHING AN INTERNATIONAL CONSENSUS ON THE DIABETIC FOOT AVAIABLE WWW.IDF.ORG/BOOKSHOP -------------------------------------------------------- REVISED BY IDF

10. 10TH SCIENTIFIC MEETING POTSDAM,GERMANY 28TH – 30TH SEPTEMBER 2012

11. THE DIABETES TEAM IN DENMARK HAS INCLUDED PODIATRIST SINCE THE 1970-IES NOW MOST EUROPEAN COUNTRIES HAVE

12. ALARMING PROPORTIONS ABOUT 15% OF THE DIABETIC PATIENTS WILL SUFFER FROM A FOOT – ULCER ONCE OR MORE DURING THEIR LIFETIME

13. ORGANIZATION OF FOOTCARE IN DENMARK FOR DM GPs PRESCRIBE PREVENTATIVE FOOTCARE AND EDUCATION AT PODIATRISTS´ STATESUPPORTED WITH 50% 1 – 6 TIMES/YEAR ACCORDING TO THE RISK-PROFILE.

14. PRESCRIBED FOOTWEAR STATESUPPORTED BY 90% INSOLES BY 100 % ORTHOTICS BY 50% PROSTHETICS FOR LEG AMPUTATION 100 % CO-WORK PODIATRIST/ SHOEMAKER

15. PODIATRY IS WHAT PODIATRISTS DO FOOT STATUS: SENSATION, BLOODSUPPLY, JOINTFUNCTION, GAIT-ABNORMALITY, SHOE-CONTROL, CLASSIFICATION IN RISK GROUPS EDUCATION ACCORDING TO RISK FACTORS. TREATMENT OF CORNS/CALLUS, NAILPROBLEMS, PROTECTION OF PRESSURE POINTS BY INSOLES AND ORTHOTICS

16. MANY PODIATRISTS WORK PARTTIME IN AN OUT-PATIENT CLINIC AND PARTTIME IN THEIR PRIVATE CLINIC, OFTEN WITH 1-2 COLLEAGES

17. WHEN A FOOTULCER OCCUR PATIENTS ARE REFERRED TO A PUBLIC DIABETES OUT-PATIENT CLINIC FOR FURTHER EXAMINATION: CULTURE HbA1c X-RAY TOE-BLOOD-PRESSURE, ORTHOP.CONSULT. OFFLOADING DEBRIDEMENT BY THE PODIATRIST IN THE HOSPITAL TEAM

18. AFTER HEALING PATIENT RETURNS TO THE PRIMARY SECTOR´S PODIATRIST FOR RE-EXAMINATION OF FOOT-STATUS RE-EDUCATION – NEW RISK-PROFILE NEW SHOES/ INSOLES /ORTHOTIC REGULARLY FOOTCARE

19. COST-BENEFIT THIS 25 YEARS CONTRACT ARRANGEMENT HAS PROVED COST- EFFECTIVE NUMBER OF FOOTULCERS DECREASED MINOR AMPUTATIONS IN-CREASED MAJOR AMPUTATIONS DECREASED

20. RISK-GROUP PATIENTS FOOTULCER-PREVIOUS FOOTULCER PREVIOUS AMPUTATION NEUROPATHY FOOT-DEFORMITY CHARCOT-FOOT LACKING FOOTPULSES OEDEMA NEPHROPATHY NAIL ABNORMALITIES WEEK EYE-SIGHT/OLD AGE/LIVING ALONE

21. SURVIVAL IS REDUCED IN PATIENTS WITH INFECTED NEURO-ISCHEMIC ULCERS 50% DIED WITHIN THE YEAR OF INFECTION Pendry E & Edmonds M, DFSG, 2006

22. A PREVIOUS FOOT ULCER IS ASSOCIATED WITH A 10 – FOLD HIGHER RISK OF AMPUTATION INFECTION WITH A 6 – FOLD HIGHER RISK COMPARED TO NON-INFECTED Reiber GE et al Ann Intern Med 117,97-105,1992

23. MAJOR AMPUTATIONS 85% IS PRECEEDED BY A NON- HEALING FOOTULCER FOOTULCERS OCCUR WHEN PREVENTION FAILS

24. QOL FOOTULCERS MAY LEAD TO ISOLATION DEPRESSION (FEAR FOR AMP.) LOST INCOME DROP-OUT OF DIABETES-CONTROL ECONOMICAL BURDEN FOR THE SOCIETY

25. MOST FOOT ULCERS CAN HEAL RELAPSES CAN BE PREVENTED REASON IS DIAGNOSED/TREATED TOE-BLOOD PRESSURE > 30 mmHg PATIENT IS WELL-EDUCATED ULCER IS WELL DEBRIDED INFECTION CONTROLLED FOOTWEAR IS SUITABLE PRESSURE POINTS OFF- LOADED/ PROTECTED

26. INFECTION? PAIN AND ERYTHEMA MAY BE ABSENT DUE TO NEUROPATHY, DIMINISHING AXON REFLEX AND FAILURE OF VASO- DILATATION FEVER AND LEUCOCYTOSIS MAY BE ABSENT EVEN IN OSTEOMYELITIS FREQUENT INSPECTION !

27. WAGNER GRADE 0 MOBILE:INSOLES – RIGID:ROCKERBARMOBILE:INSOLES – RIGID:ROCKERBAR

28. Localization of ulcers

29. DAILY LIFE FOR MANY TOES

30. SIMPLE METHOD FOR NEUROPATHIC PATIENTS

31. MIRROR – BOX EASY AND SIMPLE CONTROL .

32. INGROWN TOENAILS

33. TOE-BP-MEASUREMENT

34. AFTER TOE AMPUTATION

35. MALLEOLUS ULCER

37. AFTER MAJOR AMPUTATION

38. PREVENTION AND TREATMENT OF ULCER-ATION OF THE FOOT IN UNI-LATERALLY AMPUTATED DIABETIC PATIENTS 11/20 PATIENTS HAD A NON-REPORTED FOOT ULCER! Larsen K et al Acta orthop.scand.53,481-85,1982

39. CONSEQUENCES OF TOE AMPUTATION

40. AFTER MINOR AMPUTATION

41. HEALING OR NOT SEVERITY OF ISCHEMIA AND INFECTION COOPERATION EXPERT-TEAM AVAILABLE FUNDING CONDITIONS

42. OEDEMA

43. BULLOSIS DIABETICORUM

44. THE CHARCOT FOOT I

45. THE CHARCOT FOOT II

46. MUSGRAVE PRINT

47. CHARCOT ANKLE

48. INFORMATION ABOUT RECURRENCE – BIG VARIATION 25-50% OF RECURRENCE EVEN IN INTERVENTION GROUPS UP TO 80% OF RECURRENCE HAS BEEN REPORTED

49. AIRCAST REMOVEABLE

50. CAUSES FOR RE- ULCERATION/NEW ULCERS NEUROPATHY FOOT DEFORMITY INSUFFICIENT FOOTWEAR WERE THE CAUSES IN 63% OF ULCERS ”CONTROL YOUR STRATEGIES” Reiber GE, Lavery LA et al Diabetes Care 22, 157-162, 1999

51. CAUSES FOR RE-ULCERATION HEART DISEASE PERIPHERAL ARTERIAL DISEASE WERE THE MAJOR REASON IN 20% RECURRENCE IN AN INTERVENTION GROUP AND A MORTALITY RATE OF 51% FAGLIA ET AL, Diabetes Care 2001

52. CAUSES FOR RE-ULCERATION - NEW ULCERS THE MOST OFTEN MENTIONED: RE-EDUCATION LACKING FOOTWEAR INSUFFICIENT PODIATRY LACKING ISCHEMIA INCREASING REPORT DELAYED DROP-OUT OFTEN REPORTED

53. COST-BENEFIT SPECIALIZED FOOT-CARE FACILITIES IMPROVED HEALING COST-REDUCTION OF 50% Pieber TR et al J.Eval.Clin.Pract.13,2007

54. RESULTS MINNESOTA, USA, A 3-YEAR STUDY FREE PODIATRY, EDUCATION AND SHOEWEAR: REDUCTION IN MAJOR AND MINOR AMPUTATION: 48% NUMBER OF 1ST AMPUTATION DECLINED FROM 21/1000 RISK-GROUP PTT TO 6/1000 - - Rith-Najarian S et al, Fam Pract, 1998 Aug; 47(2): 127-32

55. DOES MY PATIENT UNDERSTAND THE CONSEQUENCES OF HIS NEUROPATHY? DOES MY PATIENT SUFFER FROM UNNESSESARY FEAR FOR AMPUTATION? !!!!!!

56. BENEFIT OF EDUCATION THE PATIENTS PRESENT THEIR FOOTPROBLEM EARLY, REDNESS OR TEMPERATUR-DIFFERENCE MAY BE REASONS THE PATIENT LEARN TO ACT AS A MEMBER OF THE DIABETES-TEAM, RESPONSIBLE FOR BG, OFFLOADING REGIME ETC.

57. CONSENSUS-REPORT: GROUP EDUCATION FOR FOOT- ULCER PREVENTION IS OBSOLET SAVE THE TIME FOR A GOOD EXAMINATION AND A GOOD EDUCATION OF THE RISK-GROUP PATIENTS

58. RISK-GROUP PATIENTS FOOTULCER-PREVIOUS FOOTULCER PREVIOUS AMPUTATION NEUROPATHY FOOT-DEFORMITY CHARCOT-FOOT LACKING FOOTPULSES OEDEMA NEPHROPATHY NAIL ABNORMALITIES WEEK EYE-SIGHT/OLD AGE/LIVING ALONE

59. MANUFACTURED SHOES SPECIALLY DESIGNED 1-YEAR STUDY, ITALY 69 PATIENTS 27% RECURRENCE INTERVENTION GROUP 58% CONTROL GROUP Uccioli L et al Diabetes Care l8,1376-781995

60. PRESCRIBED FOOTWEAR COMMON PITTFALLS FORMER LAST USED WITHOUT NESSESARY MODIFICATIONS 2) TOE-BOX TOO LOW 3) SHOES TOO NARROW 4) SHOES TOO SHORT 5) SHOES SENT BY MAIL 6) NO GUIDELINES TO SHOEMAKER Larsen K et al DFSG 2004

61. PRESCRIBED FOOTWEAR CONTROL BEFORE WEARING BY PODIATRIST (HOSPITAL/PRIMARY SECTOR) 69% SATISFACTION AFTER CORRECTION S MOST SHOEMAKERS HAVE NOW CO- WORK WITH PODIATRIST IN THE PRIMARY SECTOR , Podiatry-study 2004

62. METHODS FOR PRESSURE RELIEF IN-DEPTH-SHOES (without individually made insoles) HAVE EFFECT ON DORSAL PRESSURE AFTER 6 MONTHS NO REDUCTION IN PLANTA PRESSURE Habershaw et al, l996

63. PRESSURE RELIEF SILICONE – INJECTIONS IN PLANTA PEDIS (Metatarsal heads) PRESSURE RELIEF AFTER 1 YEAR 50% - - - 2 YEARS 0% Van Schie, 2006

64. SUCCESS CRITERIA(?) A 3-YEAR STUDY, VERY EXPERIENCED UK CLINIC 370 ULCER PATIENTS 230 PTT BECAME ULCER-FREE 48 PTT DIED WITHIN 31 MONTHS 121 PTT BECAME NEVER ULCER-FREE 92 PTT HAD RECURRENT OR NEW ULCER WITHIN 4 MONTHS

65. SUCCESS CRITERIA? THE HEALING RATE OF ULCERS? THE ABSENCE OF RECURRENCE? REDUCTION OF MAJOR AMPUTATION? LOW MORTALITY RATE?

66. ULCER-FREE SURVIVAL FOLLOWING MANAGEMENT OF FOOTULCERS IN DIABETES Pound N et al, Diabetes Med 22: 1293-94,2005

67. KEEPING DIABETIC PATIENTS MOBILE IS ENCOURAGING BRAND THE DIABETIC FOOT TO YOUR YOUNG DOCTORS

  • Login