The Diabetic Foot: Difference between revisions
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== Introduction<br> == | == Introduction<br> == | ||
Complications in the diabetic foot is mostly caused by a triad of ischemia, | Complications in the diabetic foot is mostly caused by a triad of ischemia, Diabetic Neuropathy, and infection. <ref name="L1">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)</ref><br> | ||
Statistics about the impact of diabetic foot complications:<ref name="L1" /> | Statistics about the impact of diabetic foot complications:<ref name="L1" /> | ||
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*“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.”<br> | *“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.”<br> | ||
More information on Diabetes is available from these Physiopedia pages: [http://www.physio-pedia.com/Diabetes_Mellitus_Type_2 DM Type 2] and [https://www.google.com/url?q=http://www.physio-pedia.com/Diabetes_Mellitus_Type_1&sa=U&ved=0ahUKEwil4oKywejSAhUpjlQKHQGSDzAQFggEMAA&client=internal-uds-cse&usg=AFQjCNF3CQcljj15JiG3agD9xJmlfoDExg DM Type 1], [http://www.physio-pedia.com/Diabetes Diabetes]<br> | More information on Diabetes is available from these Physiopedia pages: [http://www.physio-pedia.com/Diabetes_Mellitus_Type_2 DM Type 2] and [https://www.google.com/url?q=http://www.physio-pedia.com/Diabetes_Mellitus_Type_1&sa=U&ved=0ahUKEwil4oKywejSAhUpjlQKHQGSDzAQFggEMAA&client=internal-uds-cse&usg=AFQjCNF3CQcljj15JiG3agD9xJmlfoDExg DM Type 1], [http://www.physio-pedia.com/Diabetes Diabetes]<br> | ||
== Specific Foot Conditions<br> == | == Specific Foot Conditions<br> == | ||
=== Diabetic Foot Ulcers | === Diabetic Foot Ulcers and Delayed Wound Healing<br> === | ||
The risk of developing Peripheral Arterial Disease is increased with diabetes and ischemia is considered the biggest culprit delaying wound healing.<ref name="L1" /><br> | |||
=== Diabetic Foot | [[Pathology leading to amputation#Diabetes_Mellitus_and_Diabetic_Ulcers|Diabetes Mellitus and Diabetic Ulcers]] | ||
=== Diabetic Foot Infections<br> === | |||
Infections in a diabetic foot can rapidly spread to the rest of the body and if not treated properly could lead to a life-threatening general septic infection.<ref name="L1" /> | |||
=== Diabetic Neuropathy<br> === | |||
[http://www.physio-pedia.com/Diabetic_Neuropathy Diabetic Neuropathy] | |||
=== Diabetic Foot | === Diabetic Foot (Charcot foot/joint) === | ||
Also known as [[A parent’s guide to congenital and acquired neuromuscular and genetic disorders#Charcot-Marie-Tooth_disease|Charcot-Marie-Tooth Disease]] or [[Ankle and Foot Arthropathies#Diabetic_foot_arthropathy|Diabetic foot arthropathy]]. | |||
More information available from [http://www.nhs.uk/conditions/Charcot-Marie-Tooth-disease/Pages/Introduction.aspx Charcot-Marie-Tooth Disease] - NHS Choices (2012). <br> | |||
== Clinically Relevant Anatomy<br> == | == Clinically Relevant Anatomy<br> == | ||
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[https://www.google.com/url?q=http://www.physio-pedia.com/images/7/73/Assessment_for_diabetics.pdf&sa=U&ved=0ahUKEwjatrWb1-XSAhXpwVQKHXvtBHgQFggIMAI&client=internal-uds-cse&usg=AFQjCNFUeXF8m1jmLOFJ2MsM1-rRcmpWMA Diabetic foot/stump assessment form] <br> | [https://www.google.com/url?q=http://www.physio-pedia.com/images/7/73/Assessment_for_diabetics.pdf&sa=U&ved=0ahUKEwjatrWb1-XSAhXpwVQKHXvtBHgQFggIMAI&client=internal-uds-cse&usg=AFQjCNFUeXF8m1jmLOFJ2MsM1-rRcmpWMA Diabetic foot/stump assessment form] <br> | ||
<br> {{#ev:youtube|aVz-Ja9Grvg}} <ref name="V1">Youtube Video: The Diabetic Foot Exam https://youtu.be/aVz-Ja9Grvg</ref> | <br> {{#ev:youtube|aVz-Ja9Grvg}} <ref name="V1">Youtube Video: The Diabetic Foot Exam https://youtu.be/aVz-Ja9Grvg</ref> | ||
== Outcome Measures == | == Outcome Measures == | ||
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== Management / Interventions<br> == | == Management / Interventions<br> == | ||
=== Physical Therapy <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> | *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&amp;rct=j&amp;q=&amp;esrc=s&amp;source=web&amp;cd=1&amp;cad=rja&amp;uact=8&amp;ved=0ahUKEwjOw_PQkuvSAhXCJCYKHV_3DZkQFgghMAA&amp;url=https%3A%2F%2Fwww.idf.org%2Fsites%2Fdefault%2Ffiles%2Fattachments%2Farticle_522_en.pdf&amp;usg=AFQjCNF94y1s0ROyDphQwPkZIpo4F0Jeeg&amp;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> | *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&amp;rct=j&amp;q=&amp;esrc=s&amp;source=web&amp;cd=1&amp;cad=rja&amp;uact=8&amp;ved=0ahUKEwjB0LrwlOvSAhUJRyYKHQHKBNYQFggcMAA&amp;url=https%3A%2F%2Fwww.aan.com%2FPressRoom%2FHome%2FGetDigitalAsset%2F8478&amp;usg=AFQjCNG9I0tj3VkkBttcIwjXfJmZ77rgUg&amp;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]] | *[[Diabetes Mellitus Type 2#Medical_Management_.28current_best_evidence.29|Diabetes Medical and Physical Therapy Management]] | ||
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*The Physical Therapist is also involved in the [http://www.physio-pedia.com/Amputee_Rehabilitation rehabilitation process after an amputation]. <br> | *The Physical Therapist is also involved in the [http://www.physio-pedia.com/Amputee_Rehabilitation rehabilitation process after an amputation]. <br> | ||
<br> | <br> | ||
=== Medical Management<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> | *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 is "accompanied by a deep abscess, extensive bone or joint involvement, crepitus,<br>substantial necrosis or gangrene, or necrotising fasciitis."<ref name="L1" /> Lepäntaloa et al. recommend that "surgical intervention for moderate or severe infections is likely to decrease the risk of major amputation."<ref name="L1" /><br> | |||
<br> | <br> | ||
== Differential Diagnosis<br> == | == Differential Diagnosis<br> == | ||
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*[[A case study of a diabetic elderly amputee patient]]<br> | *[[A case study of a diabetic elderly amputee patient]]<br> | ||
Follow this [http://www.physio-pedia.com/Category:Amputee_Case_Studies link] to read more case studies. <br> | Follow this [http://www.physio-pedia.com/Category:Amputee_Case_Studies link] to read more case studies. <br> | ||
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
Revision as of 01:02, 23 March 2017
Original Editor - Your name will be added here if you created the original content for this page.
Lead Editors
Introduction
[edit | edit source]
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
[edit | edit source]
Diabetic Foot Ulcers and Delayed Wound Healing
[edit | edit source]
The risk of developing Peripheral Arterial Disease is increased with diabetes and ischemia is considered the biggest culprit delaying wound healing.[1]
Diabetes Mellitus and Diabetic Ulcers
Diabetic Foot Infections
[edit | edit source]
Infections in a diabetic foot can rapidly spread to the rest of the body and if not treated properly could lead to a life-threatening general septic infection.[1]
Diabetic Neuropathy
[edit | edit source]
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).
Clinically Relevant Anatomy
[edit | edit source]
add text here relating to clinically relevant anatomy of the condition
Mechanism of Injury / Pathological Process
[edit | edit source]
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]
- 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 is "accompanied by a deep abscess, extensive bone or joint involvement, crepitus,
substantial necrosis or gangrene, or necrotising fasciitis."[1] Lepäntaloa et al. recommend that "surgical intervention for moderate or severe infections is likely to decrease the risk of major amputation."[1]
- Antibiotic treatment is indicated in all infected wounds in combination with wound care, until the infection is cleared up.[1]
Differential Diagnosis
[edit | edit source]
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
[edit | edit source]
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 1.5 1.6 1.7 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)
