The Diabetic Foot: Difference between revisions
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== Management / Interventions<br> == | == Management / Interventions<br> == | ||
=== Physical Therapy <br> === | |||
*[[ | *Physical Therapists are involved in both the prevention and management of diabetic foot complications. <ref name="K1">Kalra S, Kalra B, Kumar N. Prevention and management of diabetes: the role of the physiotherapist. Diabetes Voice. 2007;52 (3) https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjOw_PQkuvSAhXCJCYKHV_3DZkQFgghMAA&url=https%3A%2F%2Fwww.idf.org%2Fsites%2Fdefault%2Ffiles%2Fattachments%2Farticle_522_en.pdf&usg=AFQjCNF94y1s0ROyDphQwPkZIpo4F0Jeeg&sig2=eTOGhpZ_hHxZqIMTJEqCiQ (Accessed 22 March 2017)</ref> This is done by gait, posture, and foot off-loading education and training.<ref name="K1" /> <br> | ||
*Management of painful diabetic neuropathy: <br>In a 2009 evidence-based literature review, the authors found that TENS might be effective for pain treatment in diabetic neuropathy.<ref name="D1">Dubinsky RM, Miyasaki J. Assessment: Efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review) Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2010 Jan 12;74(2):173-6. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjB0LrwlOvSAhUJRyYKHQHKBNYQFggcMAA&url=https%3A%2F%2Fwww.aan.com%2FPressRoom%2FHome%2FGetDigitalAsset%2F8478&usg=AFQjCNG9I0tj3VkkBttcIwjXfJmZ77rgUg&sig2=d-z_DivD6wzIHMaD-lxTlw (Accessed 22 March 2017)</ref> <br> | |||
*[[Diabetes Mellitus Type 2#Medical_Management_.28current_best_evidence.29|Diabetes Medical and Physical Therapy Management]] | |||
*[[Ankle and Foot Arthropathies#Diabetic_foot_arthropathy_6|Charcot Foot Medical Management]] | *[[Ankle and Foot Arthropathies#Diabetic_foot_arthropathy_6|Charcot Foot Medical Management]] | ||
*[[Ankle and Foot Arthropathies#Diabetic_foot_arthropathy_7|Charcot Foot Physical Therapy Managment]] | *[[Ankle and Foot Arthropathies#Diabetic_foot_arthropathy_7|Charcot Foot Physical Therapy Managment]] | ||
*[[A parent’s guide to congenital and acquired neuromuscular and genetic disorders#Management_3|Charcot Foot Medical and Physical Therapy Management]] | *[[A parent’s guide to congenital and acquired neuromuscular and genetic disorders#Management_3|Charcot Foot Medical and Physical Therapy Management]] | ||
*[[Diabetic Neuropathy#Management_.2F_Interventions|Diabetic Neuropathy Management/Intervention]] | *[[Diabetic Neuropathy#Management_.2F_Interventions|Diabetic Neuropathy Management/Intervention]] | ||
*The Physical Therapist is also involved in the [http://www.physio-pedia.com/Amputee_Rehabilitation rehabilitation process after an amputation]. <br> | |||
<br> | |||
=== Medical Management<br> === | |||
*Diabetic foot infection<br>Antibiotic treatment is indicated in all infected wounds in combination with wound care, until the infection is cleared up.<ref name="L1" /><br>Hospitilisation, immobilisation, and IV antibiotics are indicated for limb threatening or uncontrolled infections.<ref name="L1" /><br>Urgent surgery is indicated if the infection "accompanied by a deep abscess, extensive bone or joint involvement, crepitus,<br>substantial necrosis or gangrene, or necrotising fasciitis."<ref name="L1" /><br> | |||
<br> | |||
== Differential Diagnosis<br> == | == Differential Diagnosis<br> == |
Revision as of 00:49, 23 March 2017
Original Editor - Your name will be added here if you created the original content for this page.
Lead Editors
Introduction
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Complications in the diabetic foot is mostly caused by a triad of ischemia, Diabetic Neuropathy, and infection. [1]
Statistics about the impact of diabetic foot complications:[1]
- Foot ulcer complications are the main reason why people with diabetes are hospitalized and have to undergo amputations.
- 20-40% of all the health care costs comprised for diabetes are for diabetic foot complications
- 7-10% of patients with diabetes and neuropathy will develop an ulcer; this increases up to 30% for patients with diabetes and other comorbidities.
- 5-8% of patients will undergo a major amputation 1 year after developing a diabetic ulcer.
- A foot ulcer preceded 85% of diabetes related amputations.
- “Diabetes increases the risk of amputation 8-fold in patients aged >45 years,8 12-fold in patients aged>65 years and 23-fold in those aged 65––74 years.”
More information on Diabetes is available from these Physiopedia pages: DM Type 2 and DM Type 1, Diabetes
Specific Foot Conditions
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Diabetic Foot Ulcers[edit | edit source]
Diabetes Mellitus and Diabetic Ulcers
Diabetic Foot (Charcot foot/joint)[edit | edit source]
Also known as Charcot-Marie-Tooth Disease or Diabetic foot arthropathy.
More information available from Charcot-Marie-Tooth Disease - NHS Choices (2012).
Diabetic Foot Infections[edit | edit source]
Diabetic Delayed Wound Healing[edit | edit source]
Clinically Relevant Anatomy
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add text here relating to clinically relevant anatomy of the condition
Mechanism of Injury / Pathological Process
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add text here relating to the mechanism of injury and/or pathology of the condition
Clinical Presentation[edit | edit source]
add text here relating to the clinical presentation of the condition
Assessment[edit | edit source]
Diabetic foot/stump assessment form
Outcome Measures[edit | edit source]
add links to outcome measures here (see Outcome Measures Database)
Management / Interventions
[edit | edit source]
Physical Therapy
[edit | edit source]
- Physical Therapists are involved in both the prevention and management of diabetic foot complications. [3] This is done by gait, posture, and foot off-loading education and training.[3]
- Management of painful diabetic neuropathy:
In a 2009 evidence-based literature review, the authors found that TENS might be effective for pain treatment in diabetic neuropathy.[4]
- Diabetes Medical and Physical Therapy Management
- Charcot Foot Medical Management
- Charcot Foot Physical Therapy Managment
- Charcot Foot Medical and Physical Therapy Management
- Diabetic Neuropathy Management/Intervention
- The Physical Therapist is also involved in the rehabilitation process after an amputation.
Medical Management
[edit | edit source]
- Diabetic foot infection
Antibiotic treatment is indicated in all infected wounds in combination with wound care, until the infection is cleared up.[1]
Hospitilisation, immobilisation, and IV antibiotics are indicated for limb threatening or uncontrolled infections.[1]
Urgent surgery is indicated if the infection "accompanied by a deep abscess, extensive bone or joint involvement, crepitus,
substantial necrosis or gangrene, or necrotising fasciitis."[1]
Differential Diagnosis
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add text here relating to the differential diagnosis of this condition
Key Evidence[edit | edit source]
add text here relating to key evidence with regards to any of the above headings
Resources
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add appropriate resources here
Case Studies[edit | edit source]
- Amputation secondary to Diabetes Mellitus: Amputee Case Study
- A 35 year old diabetic Aboriginal women, who underwent a right transtibial amputation for diabetic foot ulcer and completed prosthetic rehabilitation.
- Diabetic patient amputation: Amputee Case Study
- Diabetic complications leading to amputation: Amputee Case Report
- Diabetic Patient with Bilateral Amputations : Amputee Case Study
- The Young, Diabetic Amputee: Amputee Case Study
- Bilateral Below Knee Amputation due to Diabetic Complications: Amputee Case Study
- Lower Limb Amputation: Diabetic Case Presentation: Amputee Case Study
- Older Diabetic Amputee with slow healing: Amputee Case Study
- A case study of a diabetic elderly amputee patient
Follow this link to read more case studies.
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ 1.0 1.1 1.2 1.3 1.4 Lepäntaloa M, Apelqvistc J, Setaccie C, Riccof JB, de Donatoe G, Beckerg F, Robert-Ebadig H, Caoh P, Ecksteini HH, De Rangok P, Diehml N. Chapter V: Diabetic Foot. European Journal of Vascular and Endovascular Surgery. 2011;42(S2):S60-74. http://www.angiologiaparaclinicos.com/wp-content/uploads/2013/10/Chapter-V-Diabetic-Foot.pdf (Accessed March 2017)
- ↑ Youtube Video: The Diabetic Foot Exam https://youtu.be/aVz-Ja9Grvg
- ↑ 3.0 3.1 Kalra S, Kalra B, Kumar N. Prevention and management of diabetes: the role of the physiotherapist. Diabetes Voice. 2007;52 (3) https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjOw_PQkuvSAhXCJCYKHV_3DZkQFgghMAA&url=https%3A%2F%2Fwww.idf.org%2Fsites%2Fdefault%2Ffiles%2Fattachments%2Farticle_522_en.pdf&usg=AFQjCNF94y1s0ROyDphQwPkZIpo4F0Jeeg&sig2=eTOGhpZ_hHxZqIMTJEqCiQ (Accessed 22 March 2017)
- ↑ Dubinsky RM, Miyasaki J. Assessment: Efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review) Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2010 Jan 12;74(2):173-6. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjB0LrwlOvSAhUJRyYKHQHKBNYQFggcMAA&url=https%3A%2F%2Fwww.aan.com%2FPressRoom%2FHome%2FGetDigitalAsset%2F8478&usg=AFQjCNG9I0tj3VkkBttcIwjXfJmZ77rgUg&sig2=d-z_DivD6wzIHMaD-lxTlw (Accessed 22 March 2017)