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DIABETIC FOOT CARE
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DIABETIC FOOT CARE

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  1. DIABETIC FOOT CARE BAGIAN ILMU KEDOKTERAN FISIK DAN REHABILITASI RS DR. HASAN SADIKIN BANDUNG

  2. 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

  3. INTRO………………. • DEATH CAUSED OF FOOT DIABETIC 17-32% • GOOD DIABETIC FOOT CARE WILL DECREASE AMPUTATION IN ½ - ¾ CASES

  4. DEFINITION OF DIABETIC FOOT SYNDROME FOOT ABNORMALITIES CAUSED BY NEUROPATHY, ANGIOPATHY AND INFECTION IN DIABETES MELLITUS PATIENT’S

  5. COMMON FOOT PROBLEMS CHARCOT JOINT HAMMER TOE HALUX VALGUS ULCER

  6. INGROWN TOENAILS CORN & CALLUS

  7. 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

  8. PERUBAHAN TEKANAN PADA KAKI MONOFILAMENT TEST

  9. NEUROPATI DEEP TENDON REFLEX TEST TUNING FORK – VIBRATORY SENSE

  10. ANGIOPATHY • PULSASI ARTERI DORSALIS PEDIS

  11. MANAGEMENT GOAL FOR DIABETIC FOOT • ACUTE : • WOUND HEALING • SAFE THE FOOT FROM AMPUTATION • CHRONIC : • TO PREVENT RECURRENCY OF WOUND

  12. GRADING ULCER (WAGNER CLASSIFICATION)

  13. 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

  14. LEVEL I Neuropathy Objective : No wound Intervention and plan of treatment * General foot care * Appropriate foot wear

  15. LEVEL II Neuropathy + Deformity OBJECTIVE : WOUND FREE Intervention and plan of treatment * Foot care * Preventive surgery *Protective foot wear

  16. 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)

  17. 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

  18. LONG TERM CARE • TO PREVENT RECURRENT WOUND : * EDUCATION * DIABETIC FOOT CARE

  19. 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

  20. 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.

  21. DIABETIC FOOT CARE AND EDUCATION • CHECK YOUR FEET EVERY DAY • DO YOUR SEE RED SPOTS ? • DO YOU HAVE BLISTERS OR CALLUSES ?

  22. CARE AND EDUCATION IRRITATIONS, SKIN LESIONS BLISTER CUTS BETWEEN YOUR TOES

  23. DO YOU FEEL TINGLING? • ARE YOUR FEET COLD? • ARE YOUR FEET NAILS INGROWN? • HAS YOUR ARCH DECREASED?

  24. CARE AND EDUCATION • TEST THE TEMPERATURE OF THE WATER BEFORE PUTTING YOUR FEET • WASH YOUR FEET WITH LUKEWARM WATER AND MILD SOAP

  25. CARE AND EDUCATION • KEEP SKIN SUPPLE & MOISTURISED • CUT YOUR NAIL CORRECTLY Do not cut the corner of your toe nails

  26. CARE AND EDUCATION • DO NOT WALK BARE FOOT

  27. EXAMINE YOUR FEET DAILY • DRY YOUR FEET PROPERLY • DO NOT SOAK MORE THAN 5 MINUTES

  28. DIABETIC SHOES

  29. How To Select The Right Shoes?

  30. GOOD DIABETIC SHOES…….. • Both feet measures • Deep and wide toes box • Flexible rubber soles • Cushioned insole, 0.5-1 cm thick and softness

  31. 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

  32. TYPE OF FOOTWEAR Custom Molded Shoes With Insoles

  33. TYPE OF FOOTWEAR Molded Sandal

  34. WARNING SIGNS AND SYMPTOMS OF DIABETIC FOOT PROBLEMS

  35. REMEMBER…… • EXAMINE YOUR SHOES BEFORE PUTTING THEM ON • DON’T ATTEMPT SELF TREATMENT • SEEK IMMEDIATE MEDICAL ATTENTION

  36. THANK YOU HATUR NUHUN

  37. Type of Footwear Molded Insole 1. Increasing wt.bearing area 2. Assist the foot in normal function

  38. Metatarsal bar

  39. PATOGENESIS

  40. DIABETIC FOOT LESION GRADING SYSTEM - WAGNER

  41. MANAGEMENT