The Diabetic Foot: Difference between revisions
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== Specific Foot Conditions<br> == | == Specific Foot Conditions<br> == | ||
=== Diabetic Foot Ulcers and Delayed Wound Healing<br> === | === 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> | 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> | ||
[[Pathology leading to amputation#Diabetes_Mellitus_and_Diabetic_Ulcers|Diabetes Mellitus and Diabetic Ulcers]] | [[Pathology leading to amputation#Diabetes_Mellitus_and_Diabetic_Ulcers|Diabetes Mellitus and Diabetic Ulcers]] | ||
=== Diabetic Foot Infections<br> === | === 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" /> | 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> === | === Diabetic Neuropathy<br> === | ||
[http://www.physio-pedia.com/Diabetic_Neuropathy Diabetic Neuropathy] | [http://www.physio-pedia.com/Diabetic_Neuropathy Diabetic Neuropathy] | ||
=== Diabetic Foot (Charcot foot/joint) === | === Diabetic Foot (Charcot foot/joint) === | ||
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More information available from [http://www.nhs.uk/conditions/Charcot-Marie-Tooth-disease/Pages/Introduction.aspx Charcot-Marie-Tooth Disease] - NHS Choices (2012). <br> | More information available from [http://www.nhs.uk/conditions/Charcot-Marie-Tooth-disease/Pages/Introduction.aspx Charcot-Marie-Tooth Disease] - NHS Choices (2012). <br> | ||
== Assessment == | == Assessment == | ||
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=== 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&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> | *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;amp;rct=j&amp;amp;q=&amp;amp;esrc=s&amp;amp;source=web&amp;amp;cd=1&amp;amp;cad=rja&amp;amp;uact=8&amp;amp;ved=0ahUKEwjOw_PQkuvSAhXCJCYKHV_3DZkQFgghMAA&amp;amp;url=https%3A%2F%2Fwww.idf.org%2Fsites%2Fdefault%2Ffiles%2Fattachments%2Farticle_522_en.pdf&amp;amp;usg=AFQjCNF94y1s0ROyDphQwPkZIpo4F0Jeeg&amp;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> | *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> | **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;amp;rct=j&amp;amp;q=&amp;amp;esrc=s&amp;amp;source=web&amp;amp;cd=1&amp;amp;cad=rja&amp;amp;uact=8&amp;amp;ved=0ahUKEwjB0LrwlOvSAhUJRyYKHQHKBNYQFggcMAA&amp;amp;url=https%3A%2F%2Fwww.aan.com%2FPressRoom%2FHome%2FGetDigitalAsset%2F8478&amp;amp;usg=AFQjCNG9I0tj3VkkBttcIwjXfJmZ77rgUg&amp;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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=== Medical Management<br> === | === Medical Management<br> === | ||
*Diabetic foot infection<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> | **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> | **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> | **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> | ||
== Resources <br> == | == Resources <br> == | ||
Revision as of 01:03, 23 March 2017
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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).
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]
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&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)
- ↑ 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)
