Post on 08-May-2015
description
Amputation Prevention – Keeping Your Feet Healthy
With Diabetes
Don Pelto, DPM
Central Massachusetts Podiatry, PC
Worcester, MA
Why should I listen?
You or a loved one will probably develop diabetes during your lifetime
1-4% of people with diabetes get ulcers every year and 15-25% will get one in their lifetime
15% of ulcers lead to amputation85% of amputations start as ulcers45% of people with an ulcer will die within 5
years
Poor Circulation - PAD
Neuropathy
Neuropathy
• Neuropathy– Medication Oral– Topical Medication– ENFB (Epidermal Nerve
Fiber Biopsy)
Foot Deformity - Bunions and Hammerotes
Foot Deformity – Callous / Corn
• Thickened skin caused by chronic rubbing or irritation of a bony prominence by the ground or shoe gear
Callous / Corn Treatment
• Trimming Callus• Callus Cream &
Pumice Bar• Padding• Decreasing friction • Don't use acid pads
Diabetic Ulcer
Diabetic Ulcer
Diabetic Ulcer
• 4 Reasons Why Won’t Heal• High Blood Sugar
• Poor Circulation
• Deeper Infection
• Walking on Wound
Diabetic Ulcer
Spencer SA. Pressure relieving interventions for preventing and treating diabetic foot ulcers. Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD002302. DOI:
10.1002/14651858.CD002302.
Diabetic Ulcer
Ubbink DT, Westerbos SJ, Evans D, Land L, Vermeulen H. Topical negative pressure for treating chronic wounds. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD001898. DOI: 10.1002/14651858.CD001898.pub2.
Diabetic Ulcer
• Callus– Diabetic shoes
• Ulceration– VAC– Debridement– Dermal Skin Substitute– Platelet Rich Plasma
Charcot Foot
Edwards J, Stapley S. Debridement of diabetic foot ulcers. Cochrane Database of Systematic Reviews 2010, Issue 1.
Diabetic ShoesMost patient’s with DiabetesQualify for a pair of DiabeticShoes each year.
• Partial/Complete Amputation
• Previous Ulceration
• Pre-Ulcerative Callus
• Neuropathy with Callus
• Poor Circulation• Foot Deformity
Common Foot Problems
For people with and without diabetes
Plantar Fasciitis / Heel Spur
• Inflammation and partial tearing of a ligament band
• Spur may be present
• Pain first thing in morning
Plantar Fasciitis Treatment
• New shoes• Ice• NSAIDs• Night Splint• Stretching vs Deep
Tissue Massage
Plantar Fasciitis Treatment
• Steroid Injection– 25G Needle– 3cc Syringe– 1cc 1%
Lidocaine– 1cc 0.5%
Marcaine– 0.5cc Kenalog– 0.5cc
Dexamethasone
Flat Feet
• Congenital or acquired
• Pain may occur in the feet, ankles, knees or back
Flat Feet Treatment
• Supportive Shoes
• Orthotics
• Arizona Brace
Morton’s Neuroma
• Compressed Nerve
• Most often 3rd interspace
• Burning / pain on the ball of the foot or toes
• r/o stress fracture, metatarsalgia
Morton’s Neuroma Treatment
• Wide shoes• No high heel shoes• NSAIDs• Physical Therapy• Orthotics• Metatarsal Pad• Steroid Injection• Sclerosing Injection 4%
– 48cc 0.5% Marcaine with epi
– 2cc Dehydrated Alcohol
Hallux Valgus
• Painful bump secondary to increase IM angle
• Poor biomechanics• Hurts in shoes• Usually bump pain vs
joint pain• Wider shoes help• Orthotics slow or stop
progression and pain
Hallux Valgus Treatment
• Radiographs• Wider shoes• Padding, Bunion Bra• Trimming Keratoma• Corticosteroid Injection
• Bump vs Joint
• Orthotics slow or stop progression and pain
Tailor’s Bunion / Bunionette
• Bony deformity which is located on the outside part of the foot.
• The bump, bunionette or Tailor’s Bunion, can become very painful due to shoe irritation.
Note prominent 5th metatarsal head
Hallux Rigidus
• Arthritis of 1st MPJ• Poor biomechanics• Painful to walk
Hallux Rigidus Treatment
• Cortisone injection• Physical therapy• NSAIDS• Orthotics
Hammertoe Deformity
• Digital contracture can be flexible or rigid in nature
• Usually PIPJ• May have MPJ
dorsiflexion• May have callus• Pre-ulcerative in patients
with diabetes
Hammertoe Treatment
• Debridement• Padding• Shoe gear change
Athlete's FootAthlete's Foot
• Fungal infection (Dermatophyte).
• May occur anywhere on the foot and may burn and/or itch
• The affected areas of skin will often peel or may have small blisters
Athlete's Foot TreatmentAthlete's Foot Treatment
• Topical Antifungal – Cream vs Gel
• Topical Steroid• May be dermatitis• Biopsy if not
responding
Plantar Wart
• Human Papilloma Virus (HPV)
• Contagious• Usually plantar on
foot
Verruca Treatment• Debridement• Chemocautery• Laser• Topical treatments• Oral Cimetidine for
pediatric usage (30-40Mg/Kg in 3 divided doses)
• Liquid Nitrogen not very effective on thick plantar foot skin
Ganglion Cyst
• Benign soft tissue mass which arises from a weak area in a tendon lining or joint
• Cyst is often filled with a gelatinous fluid
• Cyst may change size depending on irritation
Ganglion Cyst Treatment
• Aspiration
• Cortisone Injection
• Trauma
• Pressure
Eczema/Fissures
• Skin inflammatory condition
• Worse in winter
• Make sure not ulceration
Ezema/Fissure Treatment
• Cream
• Pumice Stone
• Off-loading Boot
Eczema/Fissure Treatment
Ingrown Nails/Paronychia
• Painful to edge of nail with pressure or tight shoes
• Erythema, edema, purulent exudate
Ingrown Nail Treatment
• Antibiotic• Massaging Nail
Edge• I&D• Phenol & Alcohol
(P&A)
Onychomycosis• Dermatophyte• Often seen with skin
manifestations• Usually acquired but may
be inherited• May be caused by trauma
Onychomycosis Treatment
• Debridement• Topical/Oral
Antifungal• Laser • Nail Avulsion• Matrixectomy• Nail Biopsy
Fungal Laser
• Kills the pathogens that cause toenail fungus (Onychomycosis).
• Painless-no anesthesia needed.
• No side effects.
• Does not harm the nail or skin.
• Usually only one treatment required.
• Shoes and nail polish can be worn immediately after treatment.
Nail Injury
• Chronic injury (i.e. athletic activities)
• Isolated injury (trauma)
• Nail bed laceration
Nail Injury Treatment
• Watch and wait
• Nail avulsion
• Puncture
Subungual Exostosis
• Bone and cartilage growth under the great toe nail
• Pain may arise if pressure is placed over the area
Subungual Exostosis Treatment
• Shoe Modification
• Toe Cap
• Nail Avulsion
• Cortisone Injection
• Exostectomy
Haglund’s Deformity / Retrocalcaneal Exostosis
• Prominent bone on the back of the heel.
• Back of the heel is irritated by shoes and activity.
Haglund’s Deformity / Retrocalcaneal Exostosis Treatment
• Open Backed Shoes
• Steroid Injection around Bursa
• Orthotics
Fractures
• 5th Metatarsal – Difficulty healing
• Digital
• Calcaneus
• Stress Fracture
Fracture 5th Metatarsal
Fracture Treatment
• Surgical Shoe
• CAM Walker
• Bone Stimulator
• Buddy Taping
• MRI vs CT
Thank You
Don Pelto, DPM
Central Massachusetts Podiatry, PC
Worcester, MA
don@worcesterfootcare.com
(508) 757-4003