Off-loading; diabetic foot ulcer

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Presentation transcript:

Off-loading; diabetic foot ulcer Nalaka Gunawansa 16.10.14

STAGES OF ULCER DEVELOPMENT

STAGES OF ULCER DEVELOPMENT

Biomechanics of foot wear Biomechanical abnormalities are consequence of neuropathy, they lead to abnormal foot pressure Foot deformity & neuropathy increase the risk of ulcer Pressure relief is essential for ulcer healing and/or prevention Frequent inspection of shoes & insoles is mandatory Appropriate foot wear significantly reduce ulcer recurrence

How To Prevent Foot Problems 5 principles Regular inspection & examination of foot & foot wear Identification of high risk patient Education of patient, family & health care providers Appropriate foot wear Treatment of non ulcerative pathology

SENSORY NEUROPATHY

AREAS AT RISK OF ULCERATION

NEURO-OSTEOARTHROPATHY(CHARCOT FOOT)

Slide 39

Slide 36

Neuropathy Management =Stop Repetitive Injury Off-load

Off-Loading: A Standard of Care Proper off-loading: Reduces pressure Reduces shear Reduces shock Transfers weigh from sensitive or painful areas Corrects or supports flexible deformities Accommodates fixed deformities reducing pressure on the diabetic foot ulcer is a vital integral component of effective wound management. Pedorthics is concerned with the design, manufacture, fit and modification of shoes and related foot appliances as prescribed for the reduction of painful or disabling conditions of the foot or limb. Proper off-loading helps reduce pressure, shear, shock, and transfer from sensitive or painful areas. It is important that diabetic patients are properly fitted for off-loading devices because they can often correct or support flexible deformities or accommodate fixed deformities. Joint motion can also be controlled and or limited. 14

Off-Loading: A Standard of Care Off-loading includes: Rest/elevation Felt/foam Multi- podus splint/boot Removable cast walker/walking boot Total contact casting (TCC) Wedge shoe Surgical shoe with pressure relief insole Other assistive devices used in addition Crutches Wheelchairs Walkers 15

FOOT WEAR

PODIATRY

Off Loading Ulcer clinic: Immediate care

Off Loading

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