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Ryan Causby B.App.Sc(Pod), Grad.Dip(Pod)

Ryan Causby B.App.Sc(Pod), Grad.Dip(Pod). The neuropathic foot. Central Northern Adelaide Health Service University of South Australia. Conditions causing neuropathy. Diabetes Alcoholism Infections Malignancies Auto-immune disease Hereditary disorders Ageing process Trauma Idiopathic.

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Ryan Causby B.App.Sc(Pod), Grad.Dip(Pod)

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  1. Ryan CausbyB.App.Sc(Pod), Grad.Dip(Pod) The neuropathic foot Central Northern Adelaide Health Service University of South Australia

  2. Conditions causing neuropathy • Diabetes • Alcoholism • Infections • Malignancies • Auto-immune disease • Hereditary disorders • Ageing process • Trauma • Idiopathic medicalimages.allrefer.com/large/alcoholic-neuropathy 10-23%, Neuropathy with no known cause.7

  3. Today: • Neuropathy...the stats • Effects of Neuropathy • Neuropathic wounds • Management

  4. 900,000 with diabetes in SA (1999) • 47.9% Diabetics had neuropathy as a complication (SA) www.dhs.sa.gov.au/pehs/cpse/diabetes_clearing_house.hml

  5. Symptoms 90 70 Objective testing 40 Electrophysiological testing 20 No Neuropathy 0 Craig Payne, 2004, Multi-disciplinary approach to the diabetic foot conference, Adelaide SA

  6. Sage, Ronald; et al., Outpatient Care and Morbidity Reducation in Diabetic Foot Ulcers Associated with Chronic Pressure Callus Journal of the American Podiatric Medicine Association, Vol. 91, No. 6, June 2001

  7. Processes leading to Ulceration • Loss of sensation • Pressure • Lack of innate nociceptive feedback • Structural changes • Fat Pad atrophy • Autonomic changes • Skin Pathology • Proprioception • Biomechanics • Soft tissue glycolisation • Charcot Foot

  8. Causes of Ulceration • 67% Neuropathic • 26% Neuro-ischaemic • 1% Ischaemic • 6% Unknown origin5

  9. Frequency of wound location • 22% 1st MPJ • 10% Plantar Hallux4 • 20% 1st MPJ • 24% 2nd MPJ • 32% 3rd MPJ6 Wound location Armstrong, et al., diabetes care, vol. 21, no. 5 1998

  10. Management of Neuropathic Wounds • Assessment • Neuro-vasc. • Dermatological • Structural • Biomechanical • Wound management • Referral! • Off-loading

  11. Off-Loading the Diabetic Foot • Weight Loss • Debridement • Footwear • Bed rest, Crutches, Wheelchairs • Felt/Foam Padding • Accommodative orthoses • Rigid sole/ Half-shoes/ Rocker-sole • Removable Cast Walkers • Total Contact Casts

  12. Off-Loading the Diabetic Foot • Weight Loss • Debridement • Footwear • Bed rest, Crutches, Wheelchairs • Felt/Foam Padding • Accommodative orthoses • Rigid sole/ Half-shoes/ Rockers/ Carbon Fibre • Removable Cast Walkers • Total Contact Casts

  13. Protection Immobilisation Check foot regularly Dressing change COMPLIANCE Protection (trauma & infection) Swelling Immobilisation Costly Time Risk of iatrogenic trauma Infection Vs

  14. Fleischli JG, Lavery LA, Vela SA, et al., Comparison of strategies to reduce pressures at the site neuropathic ulcers. Journal of the American Podiatric Medicine Association Vol. 87, 1997.

  15. Armstrong DG, Lavery LA Evidence Based options for Off-loading diabetic wounds [online],

  16. What else to think about…… • Glycaemic control • Vascular status • Infection • Weight loss • Nutrition • Chronic wounds • Bacterial Burden

  17. Questions??……………..

  18. References • Australian Institute of Health and Welfare 2002. Diabetes: Australian Facts 2002. AIHW Cat. No. CVD 20 (Diabetes Series no. 3). Canberra: AIHW (www.aihw.gov.au/publications/cvd/daf02/daf02.pdf) • Scarlet JL, Blais MR (1989): Statistics on the Diabetic Foot Journal of the American Podiatric Association Vol. 79, No. 6. 1989 • Apelqvist J, Larsson J, AgardhCD: Long-term prognosis for diabetics with foot ulcers Journal of Internal Medicine Vol. 233, No. 6, June 1993 • Armstrong DG, Lavery LA, Harkless LB: Validation of a Diabetic Wound Classification System Diabetes Care Vol. 21, No. 5, May 1998 • Boulton A., Manchester • Veves A, Murray HJ, Young MJ, Boulton AJM: The risk of ulceration in diabetic patients with high foot pressure: a prospective study Diabetologia Vol. 35 (1992)

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