1. DIBETIC FOOT ULCER ETIO-PATHOGENESIS & MANAGEMENT DR.ARUN BAL S.L.RAHEJA HOSPITAL

2. METHOD OF OFF-LOADING BEDREST CRUCTHES WHEELCHAIR SPECIAL FOOTWEAR CONTACT CASTING

3. MECHANISM OF INJURY DIRECT PENETRATION OF SKIN SMALL AMOUNT OF FORCE SUSTAINED OVER A PERIOD OF TIME MODERATE AMOUNT OF REPATATIVE FORCE

4. INDICATION OF WORSENING INFECTION INCREASED DRAINAGE INCREASED ERYTHEMA SUDDEN INCREASE IN PAIN INCREASED WARMTH FOUL ODOUR LYMPHANGITIS

5. INDICATION OF WORSENING INFECTION(CONT) INCREASED BLOOD GLUCOSE LEVEL INCREASED WBC LEVEL INCREASED E.S.R REDUCED QUADRICEPS ACTION PERSISTANT ANOREXIA HIGH SERUM CREATININE

6. OFF LOADING OF AFFECTED FOOT

7. WHAT CAUSES HIGH PLANTAR PRESSURE? DISPLACEMENT OF METATARSAL CUSHION DISTALLY NON ENZYMATIC GLYCOLISATION LIMITATION OF MOVEMENT OF 1ST MTP JOINT REDUCED ELASTICITY

8. WHAT CAUSES HIGH PLANTAR PRESSURE? DECREASED SUBTALAR JOINT MOVEMENT EXCESSIVE PLANTAR KERATOSIS THICKENING OF SESMOID ADHESIONS & SCAR TISSUE

9. HOW DOES FOOT INJURY OCCUR? PEAK PLANTAR PRESSURE:1340kPa SYSTOLIC BP 120 mm OF H:15 kPa CAPILLARY PRESSURE :6 kPa DELAYED/ABSENT RECOVERY FROM ISCHAEMIA DELAYED/ABSENT RECOVERY OF NORMAL TISSUE OXYGEN CONC.

10. HOW DOES FOOT INJRY OCCUR? REPATATIVE MODERATE FORCE INFLAMMATION ERYTHEMA AND WARMTH COLLECTION OF EXUDATE BLISTER FORMATION BREAKDOWN OF SKIN --- ULCER

11. NEED FOR PROMPT TREATMENT OF FOOT ULCER 85% OF DIABETIC FOOT AMPUTATIONS ARE DUE TO INADEQUATELY TREATED FOOT ULCER 30-50% AMPUTEES REQUIRE CONTRALATERAL AMPUTATION IN 3 YEARS

12. NEED FOR PROMPT TREATMENT IF FOOT ULCER 10% MORTALITY IN THREE YEARS IN AMPUTEES ECONOMIC LOSS TO FAMILY AND SOCIETY 22% REQUIRE IPSILATERAL HIGHER AMPUTATION

13. FOOT ULCER ASSESSMENT PERIWOUND ERYTHEMA PERIWOUND ODEMA WOUND PURULENCE WOUND FIBRIN LIMB PITTING ODEMA LIMB BRAWNY ODEMA

14. FOOT ULCER ASSESSMENT WOUND GRANULATION VASCULAR STATUS WOUND MEASUREMENT OSTEOMYLITIS & TENOSYNOVITIS

15. MECHANISM OF INJURY IN DIABETIC FOOT NORMAL STRESS SHEAR STRESS FATIGUE STRESS CONCENTRATION ELATICITY

16. PRIMARY TREATMENT OF DIABETIC FOOT ULCER EVALUATION METABOLIC CONTROL DEBRIDEMENT BACTERIAL CULTURE

17. PRIMARY TREATMENT OF DIABETIC FOOT ULCER PARENTERAL ANTIBIOTICS OFF LOADING OF AFFECTED FOOT REVASCULARIZATION CORRECT FOOTWEAR

18. OBJECTIVES OF DIABETIC FOOT WEAR REDUCTION OF EXCESSIVE PLANTAR PRESSURE REDUCTION OF SHOCK REDUCTION OF SHEAR ACCOMODATION OF DEFORMITY STABALIZATION OF DEFORMITY LIMITATION OF JOINT MOVEMENT

19. OBJECTIVES OF DIABETIC FOOTWEAR WIDE TOEBOX EXTRA DEPTH SOFT UPPERS MCR/PLASTAZOAT INSOLE INSOLE WING PAD ORTHOWDGE CORRECTION WELL FITTING SOCKS

20. SURGERY FOR DIABETIC FOOT ULCER PROPHYLACTIC THERAPEUTIC

21. PRPHYLACTIC SURGERY FOR DIABETIC FOOT ULCER METATARSAL OSTEOTOMY METATARSAL HEAD RESECTION SESMOIDECTOMY DIGITAL ARTHROPLASTY BUNIONECTOMY LOCAL FLAPS