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DIABETIC FOOT CARE. BAGIAN ILMU KEDOKTERAN FISIK DAN REHABILITASI RS DR. HASAN SADIKIN BANDUNG. INTRODUCTION. 15% DIABETIC PATIENTS WILL SUFFER FOOT PROBLEMS RISK FACTOR : MAJORITY OF PATIENTS WITH TYPE 2 DM AND LONG STANDING TYPE 1 DM

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diabetic foot care

DIABETIC FOOT CARE

BAGIAN ILMU KEDOKTERAN FISIK DAN REHABILITASI

RS DR. HASAN SADIKIN

BANDUNG

introduction
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
intro
INTRO……………….
  • DEATH CAUSED OF FOOT DIABETIC 17-32%
  • GOOD DIABETIC FOOT CARE WILL DECREASE AMPUTATION IN ½ - ¾ CASES
definition of diabetic foot syndrome
DEFINITION OF DIABETIC FOOT SYNDROME

FOOT ABNORMALITIES CAUSED BY NEUROPATHY, ANGIOPATHY AND INFECTION IN DIABETES MELLITUS PATIENT’S

common foot problems
COMMON FOOT PROBLEMS

CHARCOT JOINT

HAMMER TOE

HALUX VALGUS

ULCER

slide6

INGROWN TOENAILS

CORN & CALLUS

slide7

DM

Peripheral neuropathy

Peripheral vascular disease

Increase flow regulation

motor

Autonomic

sensory

pain 

proprioception 

Shunting

sweat 

Power imbalance

Reduced capillary blood flow

Fissuring 

Deformity

Defective response to start foot ulcer and infection

neuropati
NEUROPATI

DEEP TENDON REFLEX TEST

TUNING FORK – VIBRATORY SENSE

angiopathy
ANGIOPATHY
  • PULSASI ARTERI DORSALIS PEDIS
management goal for diabetic foot
MANAGEMENT GOAL FOR DIABETIC FOOT
  • ACUTE :
    • WOUND HEALING
    • SAFE THE FOOT FROM AMPUTATION
  • CHRONIC :
    • TO PREVENT RECURRENCY OF WOUND
slide12

GRADING ULCER

(WAGNER CLASSIFICATION)

slide13

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

slide14

LEVEL I

Neuropathy

Objective : No wound

Intervention and plan of treatment

* General foot care

* Appropriate foot wear

slide15

LEVEL II

Neuropathy + Deformity

OBJECTIVE : WOUND FREE

Intervention and plan of treatment

* Foot care

* Preventive surgery

*Protective foot wear

slide16

LEVEL III

Neuropathy + History of wound/amputation

Objective:Treat 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)

slide17

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

long term care
LONG TERM CARE
  • TO PREVENT RECURRENT WOUND :

* EDUCATION

* DIABETIC FOOT CARE

differentiation of the foot
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

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.

DIFFERENTIATION OF THE FOOT
diabetic foot care1
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.

diabetic foot care and education
DIABETIC FOOT CARE AND EDUCATION
  • CHECK YOUR FEET EVERY DAY
  • DO YOUR SEE RED SPOTS ?
  • DO YOU HAVE BLISTERS OR CALLUSES ?
slide22

CARE AND EDUCATION

IRRITATIONS, SKIN LESIONS

BLISTER

CUTS BETWEEN YOUR TOES

slide23

DO YOU FEEL TINGLING?

  • ARE YOUR FEET COLD?
  • ARE YOUR FEET NAILS INGROWN?
  • HAS YOUR ARCH DECREASED?
slide24

CARE AND EDUCATION

  • TEST THE TEMPERATURE OF THE WATER BEFORE PUTTING YOUR FEET
  • WASH YOUR FEET WITH LUKEWARM WATER AND MILD SOAP
slide25

CARE AND EDUCATION

  • KEEP SKIN SUPPLE & MOISTURISED
  • CUT YOUR NAIL CORRECTLY

Do not cut the corner of your toe nails

slide26

CARE AND EDUCATION

  • DO NOT WALK BARE FOOT
slide27

EXAMINE YOUR FEET DAILY

  • DRY YOUR FEET PROPERLY
  • DO NOT SOAK MORE THAN 5 MINUTES
good diabetic shoes
GOOD DIABETIC SHOES……..
  • Both feet measures
  • Deep and wide toes box
  • Flexible rubber soles
  • Cushioned insole, 0.5-1 cm thick and softness
good diabetic shoes1
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
type of footwear
TYPE OF FOOTWEAR

Custom Molded Shoes With Insoles

type of footwear1
TYPE OF FOOTWEAR

Molded Sandal

remember
REMEMBER……
  • EXAMINE YOUR SHOES

BEFORE PUTTING THEM ON

  • DON’T ATTEMPT SELF TREATMENT
  • SEEK IMMEDIATE MEDICAL ATTENTION
thank you

THANK YOU

HATUR NUHUN

type of footwear2
Type of Footwear

Molded Insole

1. Increasing wt.bearing area

2. Assist the foot in normal function