This document discusses the surgical treatment of diabetic foot. It provides information on various aspects of diabetic foot including causes of foot problems in diabetes, pathways of diabetic foot ulcer, reasons foot lesions are often missed, importance of high clinical suspicion, concept of plantar spaces, assessment of vascular status, principles of debridement in diabetic foot with vasculopathy, wound healing in diabetes including advantages of moist wound environment and ideal dressing methods, causes of delayed healing, agents that can delay healing, importance of antibiotic therapy and domiciliary wound care services. It also discusses local/regional anesthesia techniques for diabetic foot surgery.

1. SURGICALSURGICAL
TREATMENT OFTREATMENT OF
DIABETIC FOOTDIABETIC FOOT
DR.ARUN BALDR.ARUN BAL
MUMBAIMUMBAI

2. MANAGEMENT OFMANAGEMENT OF
DIABETIC FOOTDIABETIC FOOT
DIABETICDIABETIC
FOOTFOOT
TREATMENTTREATMENT
IN 19IN 19THTH
CENTURYCENTURY
Dr.bal

3. WHY DO DIABETES PATIENTSWHY DO DIABETES PATIENTS
GET FOOT PROBLEMS?GET FOOT PROBLEMS?
REASONSREASONS::
NEUROPATHYNEUROPATHY
VASCULOPATHYVASCULOPATHY
INJURYINJURY
Dr.bal

4. PATHWAYS FOR DIABETIC FOOT ULCER
VASCULOPATHY NEUROPATHY
MICROVASCULAR MACROVASCULAR AUTONOMIC MOTOR
SENSORY
SKIN ISCHAEMIA
SKIN DEVITALIZATION LARGE VESSEL
THROMBOSIS
DRY SKIN
PRURITIS
SMALL MUSCLE
WEAKNESS
FOOT DEFORMITY
EXTRA PRESSURE
POINT
LOSS OF
PAIN SENSATION
PAINLESS TRAUMA
FOOT

5. WHY DIABETIC FOOT LESIONSWHY DIABETIC FOOT LESIONS
ARE MANY A TIMES MISSED?ARE MANY A TIMES MISSED?
USUAL SIGNS AND SYMPTOMSUSUAL SIGNS AND SYMPTOMS
OF INFECTION ARE ABSENTOF INFECTION ARE ABSENT
PATIENT DOES NON COMPLAINPATIENT DOES NON COMPLAIN
OF PAINOF PAIN
LOW LEVEL OF AWARENESS ATLOW LEVEL OF AWARENESS AT
PRIMARY HEALTHCARE LEVELPRIMARY HEALTHCARE LEVEL
DIABETIC FOOT LESIONS AREDIABETIC FOOT LESIONS ARE
SILENTSILENT
Dr.bal

6. HIGH INDEX OFHIGH INDEX OF
SUSPICIONSUSPICION
Dr.bal

7. DIABETIC FOOT LESIONSDIABETIC FOOT LESIONS
ARE LIKEARE LIKE
ICEBERGICEBERG
ONLY SMALL PART IS VISIBLEONLY SMALL PART IS VISIBLE

8. SURFICAL TREATMENT OFSURFICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
CENTRALCENTRAL
PLANTARPLANTAR
SPACESPACE
ABCESSABCESS
Dr.bal

9. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
CENTRALCENTRAL
PLANTARPLANTAR
SPACESPACE
ABCESS AFTERABCESS AFTER
TOTALTOTAL
DEROOFINGDEROOFING
ICEBERGICEBERG
PHENOMENONPHENOMENON
Dr.bal

10. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
CENTRALCENTRAL
PLANTARPLANTAR
SPACESPACE
ABCESSABCESS
PREPRE
OPERATIVEOPERATIVE
Dr.bal

11. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
CENTRALCENTRAL
PLANTARPLANTAR
SPACESPACE
ABCESS AFTERABCESS AFTER
TOTALTOTAL
DEROOFINGDEROOFING
ICE BERGICE BERG
PHENOMENONPHENOMENON
Dr.bal

12. NO COMPLAINTNO COMPLAINT
NONO
EXAMINATIONEXAMINATION

13. TYPES OF INJURIES INTYPES OF INJURIES IN
DIABETIC FOOTDIABETIC FOOT
 SHOE BITESHOE BITE
 HOME SURGERYHOME SURGERY
 INSECT/RAT BITEINSECT/RAT BITE
 THERMAL INJURYTHERMAL INJURY
 FOREIGN BODY INJURYFOREIGN BODY INJURY
 VIGOROUS MASSAGEVIGOROUS MASSAGE
 CHEMICAL INJURYCHEMICAL INJURY
Dr.bal

14. DIABETIC FOOT INJURIESDIABETIC FOOT INJURIES
HOMEHOME
SURGERYSURGERY
Dr.bal

15. DIABETIC FOOT INJURIESDIABETIC FOOT INJURIES
THERMALTHERMAL
INJURYINJURY
Dr.bal

16. DIABETIC FOOT INJURIESDIABETIC FOOT INJURIES
THERMALTHERMAL
INJURYINJURY

17. DIABETIC FOOT INJURIESDIABETIC FOOT INJURIES
CHEMICALCHEMICAL
INJURYINJURY
dlDr.bal

18. DIABETIC FOOT INJURIESDIABETIC FOOT INJURIES
GANGRENEGANGRENE
FOLLOWINGFOLLOWING
VIGOROUSVIGOROUS
MASSAGEMASSAGE
Dr.bal

19. DIABETIC FOOT INJURIESDIABETIC FOOT INJURIES
SHOE BITESHOE BITE
Dr.bal

20. WHY FOOT NEEDS TO BEWHY FOOT NEEDS TO BE
SAVED IN DIABETES?SAVED IN DIABETES?
BK AMPUTATION REQUIRESBK AMPUTATION REQUIRES
40% MORE KCAL/MIN40% MORE KCAL/MIN
NET OXYGEN CONSUMPTIONNET OXYGEN CONSUMPTION
INCREASESINCREASES
NEEDS 5 -10 % EXTRANEEDS 5 -10 % EXTRA
CARDIAC RESERVECARDIAC RESERVE
85% MORTALITY AT THE END85% MORTALITY AT THE END
OF 5 YEARSOF 5 YEARS

21. HOW EARLY CON.AMPT.
SHOULD BE DONE?
• AS SOON AS PT.IS
HAEMODYNAMICALLY STABLE
• WITHIN 18-24 HOURS
• REGIONAL/LOCAL ANASTHESIA
• SEPTECEMIA CAN NOT BE
CONTROLLED WITHOUT EARLY
SURGERY
Dr.bal

22. GUIDELINES FOR EARLY
CON.AMPUTATION
• INDOOR CARE
• IMMEDIATE HAEMODYNAMIC
CONTROL
• EARLY SURGERY UNDER
REGIONAL/LOCALANASTHESIA
• PRE OP PARENTERAL ANTIBIOTICS
• PRE OP CREPE/COMP.BANDAGE
Dr.bal

23. GUIDELINES FOR EARLY
CON.AMPUTATION
• TOTAL DEROOFING OF AFFECTED
PLANTAR SPACE
• EXCISION OF ALL DEVITALISED
TISSUE AT THE FIRST ATTEMPT
• EXCISION OF AFFECTED TENDONS
TO ITS PROXIMAL EXTENT
• POST OP POST.PLANTAR SLAB
Dr.bal

24. GUIDELINES FOR EARLY
CON.AMPUTATION
• STRICT OFF LOADING OF THE
AFFECTED FOOT
• DRESSINGS WITH AGENTS WHICH
PROMOTE MOIST WOUND
ENVIRONMENT
• ORAL ANTIBIOTICS FOR 8-10
WEEKS
• RECONSTRUCTION/SSG
Dr.bal

25. GUIDELINES FOR EARLY
CON.AMPUTATION
• FOOTWEAR PLANNING
• FOOT EXCERCISES
• SCAR STRETCHING &
MANIPULATION
• GRADUAL MOBALISATION
• PATIENT EDUCATION FOR
PREVENTION OF FURTHER INJURY
Dr.bal

26. LOCAL/REGIONALLOCAL/REGIONAL
ANASTHESIA FORANASTHESIA FOR
DIABETIC FOOTDIABETIC FOOT
SURGERYSURGERY
Dr.bal

27. Why regional anaesthesia ?
1] Ideal for day-care patients
2] Safety in high risk patients
3] No intra-op regurgitation & aspiration
4] No PONV
5] Minimal alteration in drug schedule
-specially in diabetics
6) No change in diet schedule

28. Why regional anaesthesia ? Continued….
6] Minimal effects on vital parameters
7] Safer in emergency situations
8] Can be repeated frequently
9] Conscious & arousable patient
at the end of the surgery
10] Reduction in morbidity & mortality

29. Why not other modes of Anesthesia ??
General Anesthesia: [besides usual precautions]
a] Risk of Aspiration and PONV
b] Difficult intubations
c] Resistant hypotension which may last for longer time
d] Management of ischaemic changes and arrhythmias
e] Management of blood sugar

30. Why not other modes of Anesthesia ??
Spinal & Epidural Anesthesia
a] Prevention and management of hypotension
b] Cannot be repeated frequently
[ except in continuous epidural analgesia ]
especially for small but painful procedures.

31. Limitations
1] Surgical time limit is between
1-3 hrs.
2] Patient’s co-operation is must
3] Failure or partially acted block

32. Pre-block preparation
Counseling the patient
regarding the procedure
and the expectation from the patient
(compliance and accurate replies
regarding paresthesia)

33. Lower leg block or modified ankle block
Deep peroneal nerve – can be
blocked by injecting
subcutaneously
3-5 mm along the lat border
of the shin with 2 ml 2%
xylocaine with 24 g 1.5 inch
needle

34. Lower leg block or modified ankle block
Post. Tibial nerve –
Blocked by injecting
3-5 ml 2% xylocaine
at the junction of proximal 1/3rd
with distal 2/3rd of medial
malleolus to calcaneum, where
normally pulsations of post.
Tibial artery is felt.

35. Sural nerve
Inject 2% xylocaine
between the tendoachilles
and the calcaneaum on
the lateral aspect
Lower leg block or modified ankle block

36. Calcaneal nerve block
2 Finger breadths
proximal to the
medial malleolus
Inject along the
direction of the nerve
Lower leg block or modified ankle block

37. Practice regularly
Your patience
The surgeons’ patience
The patients’ patience!
Steps to success with local blocks
Patients’ comfort
The surgeons comfort
Your comfort
AND SAFETY!!

38. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
POST OPPOST OP
PLANTAR SLABPLANTAR SLAB
TO STABILIZETO STABILIZE
ANKLE JOINTANKLE JOINT
Dr.bal

39. CONCEPT OFCONCEPT OF
PLANTAR SPACESPLANTAR SPACES

40. CONCEPT OF PLANTAR
SPACES

41. PLANTAR SPACES

43. ASSESSMENT OFASSESSMENT OF
VASCULAR STATUS INVASCULAR STATUS IN
DIABETIC FOOTDIABETIC FOOT
A/B INDEXA/B INDEX
SEGMENTAL PRESSURESEGMENTAL PRESSURE
MEASUREMENTMEASUREMENT
COLOUR DOPPLERCOLOUR DOPPLER
DUPLEX SCANDUPLEX SCAN
ANGIOGRAPHYANGIOGRAPHY

44. DEBRIDEMENT IN DIABETICDEBRIDEMENT IN DIABETIC
FOOT WITH VASCULOPATHYFOOT WITH VASCULOPATHY
 PRE OP VASCULAR ASSESSMENTPRE OP VASCULAR ASSESSMENT
MANDATORYMANDATORY
 LOCAL DEBRIDEMENT BEFORELOCAL DEBRIDEMENT BEFORE
REVASCULARIZATION IF WOUND ISREVASCULARIZATION IF WOUND IS
INFECTEDINFECTED
 TOTAL DEBRIDEMENT AFTERTOTAL DEBRIDEMENT AFTER
REVASCULARIZATION TOREVASCULARIZATION TO
REDUCE/REMOVE NECROTIC LOADREDUCE/REMOVE NECROTIC LOAD
 TOTAL OFF LOADING TILL WOUNDTOTAL OFF LOADING TILL WOUND
HEALSHEALS

45. DEBRIDEMENT IN DIABETICDEBRIDEMENT IN DIABETIC
FOOT WITH VASCULOPATHYFOOT WITH VASCULOPATHY
DIABETIC FOOTDIABETIC FOOT
GANGREME WITHGANGREME WITH
VASCULOPATHYVASCULOPATHY

46. DEBDRIDEMENT IN DIABETICDEBDRIDEMENT IN DIABETIC
FOOT WITH VASCULOPATHYFOOT WITH VASCULOPATHY
MRANGIOGRAPHYMRANGIOGRAPHY
SHOWING BELOWSHOWING BELOW
KNEE VASCULARKNEE VASCULAR
BLOCKBLOCK

47. DEBRIDEMENT IN DIABETICDEBRIDEMENT IN DIABETIC
FOOT WITH VASCULOPATHYFOOT WITH VASCULOPATHY
POST OPPOST OP
RECURRENTRECURRENT
TENOSYNOVITISTENOSYNOVITIS

56. WOUND HEALING INWOUND HEALING IN
DIABETESDIABETES
ADVANTAGESADVANTAGES
OF MOISTOF MOIST
WOUNDWOUND
ENVIRONMENTENVIRONMENT
Dr.bal

57. PRINCIPLES OF DRESSING IN
DIABETIC FOOT WOUNDS
• MAINTAIN MOIST ENVIRONMENT
• NON ADEHERENT
• ABSORBABLE
• EASY TO USE MATERIAL
• COST EFFECTIVE
• PROMOTES HEALING
• REDUCES COLONISATION OF
BACT.
Dr.bal

58. CAUSES OF DELAYED/NON
HEALING IN DIABETIC FOOT
PRIMARY CAUSES
• INADEQUATE OFF LOADING
• INCORRECT VASCULAR
ASSESSMENT
• INADEQUATE PRELIMINARY
DEBRIDEMENT
Dr.bal

59. CAUSES OF DELAYED/NON
HEALING IN DIABETIC FOOT
SECONDARY CAUSES
• INADEQUATE ANTIBIOTIC
THERAPY
• NEPHROPATHY
• DRUGS
• ASSOCIATED TUBERCULOSIS
• INCORRECT METHOD OF
DRESSING Dr.bal

60. AGENTS THAT DELAY
WOUND HEALING IN
DIABETES
 CORTICOSTEROIDS
NITROFURANTOIN
LIQUID DETERGENTS
NEOMYCIN SULPHATE
Dr.bal

61. AGENTS THAT DELAY WOUND
HEALING IN DIABETES
CHLORHEXIDINE 2%
POVIDONE IODINE 10%
EUSOL SOLUTION
HYDROGEN PEROXIDE
Dr.bal

62. IDEAL METHOD OF DRESSING
IN DIABETIC FOOT
• IRRIGATE WITH STERILE SALINE
• IMMEDIATE POST OP USE PARAFFIN
GAUZE
• FREQUENCY OF DRESSINGS DEPEMDS
UPON AMOUNT OF EXUDATE
• USE ANTI BACTERIAL OINT. TO REDUCE
COLONIZATION
• USEAFFIRDABLE, ACCESIBLE
MATERIAL TO MAINTAIN MOIST
WOUND ENVIRONMENT
Dr.bal

63. DIABETIC FOOT WOUNDSDIABETIC FOOT WOUNDS
NEED TO BENEED TO BE IRRIGATEDIRRIGATED
AND NOTAND NOT CLEANEDCLEANED
Dr.bal

64. DOMICIALLARY WOUND
CARE SERVICES
Dr.bal

65. ANTIBIOTIC THERAPY INANTIBIOTIC THERAPY IN
DIABETIC FOOTDIABETIC FOOT
NEEDED FOR PROLONGED DURATIONNEEDED FOR PROLONGED DURATION
COST OF THE ANTIBIOTICS ISCOST OF THE ANTIBIOTICS IS
IMPORTANT FACTORIMPORTANT FACTOR
ANEROBIC CULTUREANEROBIC CULTURE
DEERPER TISSUE CULTURESDEERPER TISSUE CULTURES
ANTIBIOTICS PROTOCOL FORANTIBIOTICS PROTOCOL FOR
INSTITUTIONSINSTITUTIONS
Dr.bal

66. MEDIAL ASPECT OF FOOT DEROOFED,
WIDELY DRAINED & EXICISION OF FLEXOR HALLLUSIS
LONGUS
Dr.bal

67. DEBRIDEMENT IN DIABETICDEBRIDEMENT IN DIABETIC
FOOT WITH VASCULOPATHYFOOT WITH VASCULOPATHY
 PRE OP VASCULAR ASSESSMENTPRE OP VASCULAR ASSESSMENT
MANDATORYMANDATORY
 LOCAL DEBRIDEMENT BEFORELOCAL DEBRIDEMENT BEFORE
REVASCULARIZATION IF WOUND ISREVASCULARIZATION IF WOUND IS
INFECTEDINFECTED
 TOTAL DEBRIDEMENT AFTERTOTAL DEBRIDEMENT AFTER
REVASCULARIZATION TOREVASCULARIZATION TO
REDUCE/REMOVE NECROTIC LOADREDUCE/REMOVE NECROTIC LOAD
 TOTAL OFF LOADING TILL WOUNDTOTAL OFF LOADING TILL WOUND
HEALSHEALS
Dr.bal

72. DEBRIDEMENT IN DIABETICDEBRIDEMENT IN DIABETIC
FOOT WITH VASCULOPATHYFOOT WITH VASCULOPATHY
DIABETIC FOOTDIABETIC FOOT
GANGREME WITHGANGREME WITH
VASCULOPATHYVASCULOPATHY

73. DEBDRIDEMENT IN DIABETICDEBDRIDEMENT IN DIABETIC
FOOT WITH VASCULOPATHYFOOT WITH VASCULOPATHY
MRANGIOGRAPHYMRANGIOGRAPHY
SHOWING BELOWSHOWING BELOW
KNEE VASCULARKNEE VASCULAR
BLOCKBLOCK

74. DEBRIDEMENT IN DIABETICDEBRIDEMENT IN DIABETIC
FOOT WITH VASCULOPATHYFOOT WITH VASCULOPATHY
POST OPPOST OP
RECURRENTRECURRENT
TENOSYNOVITISTENOSYNOVITIS

75. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
RECONSTRUCTION OFRECONSTRUCTION OF
FORE FOOT ULCERFORE FOOT ULCER
WITHWITH
NEUROVASCULARNEUROVASCULAR
FLAPFLAP
Dr.bal

76. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
RECONSTRUCTIONRECONSTRUCTION
OF CHRONIC MIDOF CHRONIC MID
FOOT ULCER INFOOT ULCER IN
CHARCOT`S FOOTCHARCOT`S FOOT
Dr.bal

77. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
CLOSURE OF FORECLOSURE OF FORE
FOOT ULCERFOOT ULCER
Dr.bal

78. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
RECONSTRUCTIONRECONSTRUCTION
OF CHRONIC HEELOF CHRONIC HEEL
ULCERULCER
Dr.bal

79. SURGICAL TREATMENT OF CHARCOT`S
FOOT

80. SURGICAL TREATMENT OF CHARCOT`S
FOOT

81. SURGICAL TREATMENT OF CHARCOT`S
FOOT

82. SURGICAL TREATMENT OF CHARCOT`S FOOT

85. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
BILATERALBILATERAL
FOOTFOOT
ABCESSESSABCESSESS
Dr.bal

86. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
HEALEDHEALED
BILATERALBILATERAL
PLANTARPLANTAR
ABCESS WITHABCESS WITH
TOTAL OFFTOTAL OFF
LOADING ANDLOADING AND
MOISTMOIST
ENVIRONMENTENVIRONMENT
DRESSINGSDRESSINGS
Dr.bal

88. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
BILATERALBILATERAL
DEFORMEDDEFORMED
WALKABLEWALKABLE
FOOTFOOT
Dr.bal

89. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
DEFORMEDDEFORMED
FOOT IS BETTERFOOT IS BETTER
THAN ATHAN A
SOPHISTICATEDSOPHISTICATED
PROSTHESISPROSTHESIS
Dr.bal

90. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
REMOVAL OFREMOVAL OF
TENDONS OF FHLTENDONS OF FHL
AND T.POST FORAND T.POST FOR
TENOSYNOVITISTENOSYNOVITIS
WITH ABCESSWITH ABCESS
Dr.bal

117. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
HEEL ABCESSHEEL ABCESS
FOLLOWINGFOLLOWING
INFECTEDINFECTED
FISSURESFISSURES
Dr.bal

118. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
TOTALTOTAL
DEROOFINGDEROOFING
OF HEELOF HEEL
ABCESSABCESS
Dr.bal

119. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
NECROTISINGNECROTISING
FASCITISFASCITIS
PREPRE
OPERATIVEOPERATIVE
Dr.bal

120. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
NECROTISINGNECROTISING
FASCITISFASCITIS
AFTER TOTALAFTER TOTAL
DEROOFINGDEROOFING
ICEBERGICEBERG
PHENOMENONPHENOMENON
Dr.bal

121. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
HEALEDHEALED
MEDIALMEDIAL
PLANTARPLANTAR
SPACESPACE
ABCESSABCESS
Dr.bal

122. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIABETIC FOOTDIABETIC FOOT
HEALEDHEALED
CENTRALCENTRAL
PLANTARPLANTAR
SPACESPACE
ABCESSABCESS
Dr.bal

123. SURGICAL TREATMENT OFSURGICAL TREATMENT OF
DIEBTIC FOOTDIEBTIC FOOT
HEALEDHEALED
LATERALLATERAL
PLANTARPLANTAR
SPACESPACE
ABCESSABCESS
Dr.bal

124. TEAM WORKTEAM WORK
Dr.bal

125. PATIENT IS MOSTPATIENT IS MOST
IMPORTANTIMPORTANT
MEMBER OF THEMEMBER OF THE
TEAMTEAM

126. DIABETIC FOOT SURGERY
ADEQUATE
DRAINAGE OF
INFECTION

127. DIABTIC FOOT SURGERY
FOOT EXPLORATION

128. ST.VINCENT`SST.VINCENT`S
DECLARATIONDECLARATION
TO REDUCE THETO REDUCE THE
MAJOR AMPUTAIONSMAJOR AMPUTAIONS
DUE TO DIABETES BYDUE TO DIABETES BY
50% IN 5 YEARS50% IN 5 YEARS
Dr.bal

129. THE DIABETIC FOOT
• IF OFF LOADING OF THE
AFFECTED FOOT IS NOT DONE
THEN PATIENT
WALKS TO DEATH
Dr.bal

130. TAKE HOME MESSAGESTAKE HOME MESSAGES
EARLY RADICAL DEBRIDEMENTEARLY RADICAL DEBRIDEMENT
UNDER REGIONAL/LOCALUNDER REGIONAL/LOCAL
ANASTHESIA CAN PREVENT LEGANASTHESIA CAN PREVENT LEG
AMPUTATION IN DIABETESAMPUTATION IN DIABETES
CORRECT VASCULARCORRECT VASCULAR
ASSESSMENT AND STRICT OFFASSESSMENT AND STRICT OFF
LOADING ARE KEYS TO SUCCESSLOADING ARE KEYS TO SUCCESS
IN DIABETIC FOOT SURGERYIN DIABETIC FOOT SURGERY

131. TAKE HOME MESSAGESTAKE HOME MESSAGES
AVOID USE OF DRESSINGAVOID USE OF DRESSING
MATERIAL WHICH PREVENTSMATERIAL WHICH PREVENTS
MOIST WOUND ENVIRONMENTMOIST WOUND ENVIRONMENT
CORRECTION OF FOOTCORRECTION OF FOOT
BIOMECHANICS AFTER WOUNDBIOMECHANICS AFTER WOUND
HELASHELAS

132. NEED TONEED TO
REVIVE THEREVIVE THE
AGE OLDAGE OLD
CULTURE OFCULTURE OF
FOOTCAREFOOTCARE
ANDAND
FOOTWEARFOOTWEAR
Dr.Bal

133. THANK YOUTHANK YOU