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Diabetic Foot

Diabetic Foot

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Diabetic Foot

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  1. Diabetic Foot Linda Ferris Foot and Ankle Centre, North Adelaide Presented at the combined SAON & SAWMA Education meeting May 2006

  2. Goal • Maintain a viable plantigrade foot • Functional • Free of Infection

  3. Education program for patients and all primary health care providers of the foot Not really geared to surgeons Who looks after foot surgery very variable based on location ?Multidisciplinary teams Prevention LEAP = Lower extremity amputation prevention program

  4. Priorities • If no infection first priority is to check circulation • If pus under pressure it needs to be released first • then check circulation • if adequate circulation then can address underlying pathology

  5. Indications- Dead, dirty, devitalized, dangerous An early amputation of a small area may save more of the foot in the long run Forefoot _Amputations

  6. Forefoot deformities such as bunion, claw toes especially if inappropriate shoes High risk for developing ulcers Key is education and regular podiatry, shoe fitting Deformity in the presence of neuropathy

  7. Heal first by unloading: may include Achilles lengthening If can prevent recurrence without surgery if not then options include Keller’s and Metatarsal head excision Ulcer - forefoot

  8. In presence of diabetes and bunions risk/reward more complex in that higher risk of complications Don’t recommend surgery unless all other options considered first but if any ulceration, infection then often simplest procedure Role of “prevention”

  9. Usually associated with a charcot foot and commonly plantar ulcers May heal but tend to recur Midfoot Midfoot deformities

  10. If old Charcot then bumpectomy may be valid Lateral prominence of 5th MT base is another area that may need trim esp if cavovarus foot (eg CMT) Midfoot - rocker bottom foot

  11. Hindfoot and Ankle deformities • Often after trauma especially ankle fractures • May be chronic pre-existing deformity

  12. Ankle Fractures - to operate or not?? • Either way high risk 1 study in Ca showed if diabetic and alcoholic 100% complication rate for ankle fractures • Latest trend is to more aggressively internally fix with screws across fib to tib and possibly steinman pin up the heel but whichever way it needs to be closely followed and double NWB period and immobilization

  13. Heel Ulcers/Osteomyelitis • More difficult to unload often poor vascularity.Pressure sores need mainly nursing care different to plantar ulcers.Once down to bone if VAC system doesn’t help then may need calcanectomy which is a deforming procedure and tends to mean forever custom shoes. If poor circulation may end up with BK

  14. Symes procedure for chronic nail infection deformity Other procedures such as Zadiks work but all slow to heal in diabetics Nails