DM foot: silent killer

1. DIABETIC FOOT: SILENT
KILLER
FACEBOOK: HAPPY FRIDAY KNIGHT
PATIENT CARE TEAM: SURGERY
13TH NOV 2020

2. OUTLINES
• DEFINITION
• EPIDEMIOLOGY
• PATHOPHYSIOLOGY
• HISTORY TAKING, PHYSICAL EXAMINATION, AND INVESTIGATION
• CLASSIFICATION
• MANAGEMENT

3. DEFINITION
• DIABETIC FOOT: SIGNS AND SYMPTOMS FROM
• NEUROPATHY
• ISCHEMIA
• INFECTION

4. EPIDEMIOLOGY
• COMPLICATIONS FROM DF RESULTS IN HIGH MORBIDITY AND MORTALITY: LIMB LOSS AND
DEATH
• 70% OF MAJOR AMPUTATION ARE FROM DF
• 50% DEATH AFTER AMPUTATION: FROM ATHEROSCLEROTIC DISEASE

5. PATHOPHYSIOLOGY
• MULTIFACTORIAL
• NEUROPATHY
• VASCULAR INSUFFICIENCY
• INFECTION
• MUSCLE AND BONE DEFORMITIES

8. https://www.healthline.com/health/charcot-foot#pictures

9. HISTORY TAKING
GENERAL MEDICAL HISTORY
• FAMILY HISTORY OF DM
• OCCUPATIONAL NEEDS
• ATHEROSCLEROTIC DISEASE AND OTHER
COMORBIDITIES
• NUTRITIONAL STATUS
• SURGICAL HISTORY AND HOSPITALIZATION
• GLYCEMIC MANAGEMENT
• ETC
FOOT-SPECIFIC HISTORY
• FOOT HISTORY: DISEASE, FOOTWEAR, PAIN,
CONTACT, DEFORMITY CLAUDICATION, PRESSURE,
EDEMA
• WOUND AND ULCER HISTORY
• INCENTIVE
• DURATION
• RECURRENCE
• SIZE AND LOCATION
• WOUND CARE

10. PHYSICAL EXAMINATION
• VASCULAR
• NEUROLOGIC
• DERMATOLOGIC
• MUSCULOSKELETAL

24. MANAGEMENT
• GENERAL MANAGEMENT OF DIABETES
• RISK ASSESSMENT
• FOOT MANAGEMENT
• WOUND
• PATIENT EDUCATION

25. GENERAL MANAGEMENT OF DIABETES
• GLYCEMIC CONTROL: DIABETIC GUIDELINES
• HBA1C < 6.5%
• ATHEROSCLEROTIC DISEASE MANAGEMENT: STROKE, MI, DIABETIC NEPHROPATHY. DIABETIC
RETINOPATHY, PERIPHERAL VASCULAR DISEASE
• BLOOD PRESSURE CONTROL
• SMOKING CESSATION

27. FOOT MANAGMENT
• OFFLOADING:
• GENERALIZE PRESSURE
• MINIMIZE PRESSURE ON THE WOUND AND PREVENT RECURRING
• FOOTWEAR

33. WOUND MANAGEMENT
• DEBRIDEMENT OR AMPUTATION
• ANTIBIOTICS IN DFI
• WOUND CARE AND DRESSING

35. REFERENCES
• SIDAWAY AN, PERLER BA. RUTHERFORD’S VASCULAR SURGERY AND ENDOVASCULAR SURGERY.
9TH ED. ELSEVIER: PHILADELPHIA, 2019.
• WANG A, ET AL. GUILDELINES ON MULTIDISCIPLINARY APPROACHES FOR THE PREVENTION AND
MANAGEMENT OF DIABETIC FOOT DISEASE (2020 EDITION). BURNS & TRAUMA. 8: 2020.
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