Post on 15-Aug-2015
Prevention of amputation in
diabetes: A fact or fiction
Mamdouh El-Nahas
Professor and the Head of Diabetes and Endocrinology Unit,
Mansoura University
Chairman of the Egyptian Society of Diabetic foot
Gangrene is
the most
devastating
complication
of diabetes
Up to 70% of all leg amputations happen to
people with diabetes.
Every 30 seconds a leg is lost to diabetes
somewhere in the world.
Of all late complications of diabetes, foot problems
are the easiest to detect.
Relatively simple interventions can reduce
amputations by 50 - 80%. (Bakker et al 1994).
However, DF complications are
still neglected
The term Diabetic Foot is usually used to
indicate advanced foot pathology
Gangrene
Advanced Foot
Pathology
High Risk Foot
Low risk Foot
Gangrene
Advanced Foot Pathology
Advanced foot Pathology
Diabetic Foot ulcers
Diabetic foot Infections
Charcot foot
Critical limb ischemia
DFUs
Neuropathic Neurischemic Ischemic
Neuropathic Ulcer
Ischemic ulcers
Gangrene
Advanced Foot Pathology
High Risk Foot
Peripheral sensorimotor neuropathy Peripheral vascular disease Altered foot biomechanics History of foot ulceration or lower limb
amputation Deformity Trauma Skin and Nail pathology Nephropathy and renal dialysis
Risk factors for advanced foot
pathology
Peripheral sensorimotor neuropathy Peripheral vascular disease Altered foot biomechanics History of foot ulceration or lower limb
amputation Deformity Trauma Skin and Nail pathology Nephropathy and renal dialysis
Risk factors for DFUs
Peripheral sensorimotor neuropathy Peripheral vascular disease Altered foot biomechanics History of foot ulceration or lower limb
amputation Deformity Trauma Skin and Nail pathology Nephropathy and renal dialysis
Risk factors for DFUs
A major risk factor for lower-extremity
amputation, especially in patients with diabetes.
A marker for systemic vascular disease.
Peripheral sensorimotor neuropathy Peripheral vascular disease Altered foot biomechanics History of foot ulceration or lower limb
amputation Deformity Trauma Skin and Nail pathology Nephropathy and renal dialysis
Risk factors for DFUs
Peripheral sensorimotor neuropathy Peripheral vascular disease Altered foot biomechanics History of foot ulceration or lower limb
amputation Deformity Trauma Skin and Nail pathology Nephropathy and renal dialysis
Risk factors for DFUs
History of previous foot ulceration or lower limb
amputation are the strongest risk factors to the
recurrence of ulcers in diabetic patients
Peripheral sensorimotor neuropathy Peripheral vascular disease Altered foot biomechanics History of foot ulceration or lower limb
amputation Deformity Trauma Skin and Nail pathology Nephropathy and renal dialysis
Risk factors for DFUs
Peripheral sensorimotor neuropathy Peripheral vascular disease Altered foot biomechanics History of foot ulceration or lower limb
amputation Deformity Trauma Skin and Nail pathology Nephropathy and renal dialysis
Risk factors for DFUs
Peripheral sensorimotor neuropathy Peripheral vascular disease Altered foot biomechanics History of foot ulceration or lower limb
amputation Deformity Trauma Skin and Nail pathology Nephropathy and renal dialysis
Risk factors for DFUs
Peripheral sensorimotor neuropathy Peripheral vascular disease Altered foot biomechanics History of foot ulceration or lower limb
amputation Deformity Trauma Skin and Nail pathology Nephropathy and renal dialysis
Risk factors for DFUs
Patients with all stages of diabetic nephropathy were found to have an increased risk of DFU.
The introduction of a podiatry service into a dialysis unit resulted in a prompt and significant reduction in the incidence of amputation in the space of just 1 year (McMurray et al 2002).
Gangrene
Advanced Foot
Pathology
High Risk Foot
Low risk Foot
How to prevent amputation in
diabetic subjects?
To prevent amputation, we should diagnose
and treat any mild foot pathology before
its progression into advanced foot
pathology
Low Risk Foot
High Risk Foot
Advanced Foot
Pathology
Gangrene
A simple plan to prevent amputation (IWGDF)
Regular inspection and examination of the foot.
Identification of the foot at risk.
Education of patient, family and healthcare providers.
Appropriate footwear.
Treatment of non ulcerative pathology
A simple plan to prevent amputation (IWGDF)
Regular inspection and examination of the foot.
Identification of the foot at risk.
Education of patient, family and healthcare providers.
Appropriate footwear.
Treatment of non ulcerative pathology
The low tech high touch approach
A simple plan to prevent amputation (IWGDF)
Regular inspection and examination of the foot.
Identification of the foot at risk.
Education of patient, family and healthcare providers.
Appropriate footwear.
Treatment of non ulcerative pathology
Category
Risk profile
Check-up frequency
0 No sensory neuropathy
once a year
1 Sensory neuropathy
once every 6 months
2 sensory neuropathy and signs
of peripheral vascular disease
and/or foot deformities.
once every 3 months
3 previous ulcer or amputation
once every month
A simple plan to prevent amputation (IWGDF)
Regular inspection and examination of the foot.
Identification of the foot at risk.
Education of patient, family and healthcare providers.
Appropriate footwear.
Treatment of non ulcerative pathology
WWW.ESDF.me
A simple plan to prevent amputation (IWGDF)
Regular inspection and examination of the foot.
Identification of the foot at risk.
Education of patient, family and healthcare providers.
Appropriate footwear.
Treatment of non ulcerative pathology
A simple plan to prevent amputation (IWGDF)
Regular inspection and examination of the foot.
Identification of the foot at risk.
Education of patient, family and healthcare providers.
Appropriate footwear.
Treatment of non ulcerative pathology
In shoe
plantar
pressure
before CMI
In shoe
plantar
pressure
after CMI
Conclusions
To prevent amputation in Diabetes
Put feet first prevent amputation
Superior doctors prevent the disease
Mediocre doctors treat the disease before evident
Inferior doctors treat the full-blown disease
Huang Dee, China, B.C. 2600
Thank you