2. Diabetic Foot UlcerRole of Physiotherapist T. Senthilkumar M.P.T (Ortho).,M.I.A.P Asst. Professor Shanmuga College Of Physiotherapy
3. What is Diabetes Mellitus? Diabetes Mellitus is a group of metabolic disorders characterized by high levels of blood glucose resulting from defects in insulin production,or action, or both.
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5. Type 2
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7. Contd.. 45% of diabetics will have peripheral vascular disease after 20 years After first below –knee amputation 42% of patients with lose the contra lateral limb within 1 year 11-40% of patients will die within first year of their below-knee amputations Source: WHO Statistics on Diabetic Foot Ulcer
8. Diabetic Foot ? The term diabetic foot has been coined to encompass a multitude of leg / foot presentation where the underlying disease is Diabetes Mellitus.
19. Normal Foot Function Heel Strike The foot assists in shock absorption. The foot and leg are required to be a loose chain structure. Mid Stance The foot supports the entire body. A stable structure is required Propulsion The foot is required to adapt to the needs for propulsion. A rigid lever is required
20. Normal Foot Function contd.. Heel Strike - Subtalar joint pronates and allows shock absorption Mid Stance – Subtalar joint comes to neutral position and acts as stable structure Propulsion – Subtalar joint supinates and acts as rigid lever
55. “The Whole problem is really one of mechanics not of Medicine”- Dr Paul Brand
56. Assessment and Investigations History Neurological Examination (sensory) Foot Biomechanical Assessment Wound assessment Radiological Examination Pedobarography F - Scan
57. Examinations 1. Touch and pressure - Semmes Weinstein Nylon Monofilament 10gm 2. Vibration Perception Threshold (VPT)- by tuning fork 3. Thermal thresholds i.e. sensation of heat and cold 4. Foot pressure measurements by pedobarograph 5.Reflex assessment by using tendon hammer
58. Foot Functional Assessment Ask the patient to walk on the spot for a few seconds. Ask the patient to stop, stand still and look straight ahead. Look at the heel to see it turns in or out. Everted Heel Normal Heel Inverted Heel
60. Prevention and Education Proper education about insensitive foot Regular examination of the sole of the foot Immediate reporting if there is any change in sensory perception or motor abnormality Checking nails for blood flow or any discoloration Check feet regularly for blood circulation, and blisters, callus, corns, wound
61. Contd…. Soak the feet for 20-30 minutes in cold water to keep the foot supple and smooth (especially those who have fissures and cracks) Dress the wound properly Give adequate rest to the affected part Avoid long distance walking Wear Proper Footwear
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63. To check the area at risk of foot ulcers and give utmost care to that risky areas
74. To teach Off Loading techniques that means train crutch walking, wheel chair training
75. During off loading its necessary to prevent muscle wasting by active physio for leg & foot muscles
76. To identify the excessive pressure areas and advice suitable foot wears
77. To concentrate the dry skin to avoid that advice soaking training in cold waterContd..
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79. Objectives of diabetic foot wear Relief of excessive plantar pressure Reduction of shock Reduction shear (frictional forces) Accommodation of minimal deformity Stabilization of deformity Preventing recurrence of ulcer
80. Splinting Total contact Cast is the appropriate way of resting the foot with diabetic plantar ulcer It Distributes weight along the entire plantar aspect of the foot. It Reduces shear forces normally present between the foot and shoe. It Produces shortened stride length and a decreased walking velocity.
81. Various types of Rocker Soles Mid rocker soles – to relieve pressure metatarsal Heel to toe rocker soles – fixed claw toes, hammer toes, calcaneal ulcers Toe only rocker soles – ulcer metatarsal heads Severe angle rocker sole – hallux rigidus, ulcer on the distal part of toe, hammer toe, ulcer metasal heads Negative heel rocker sole – fixed ankle in dorsiflexion
