1. DIABETIC FOOT CARE BAGIAN ILMU KEDOKTERAN FISIK DAN REHABILITASI RS DR. HASAN SADIKIN BANDUNG

2. INTRODUCTION 15% DIABETIC PATIENTS WILL SUFFER FOOT PROBLEMS RISK FACTOR : MAJORITY OF PATIENTS WITH TYPE 2 DM AND LONG STANDING TYPE 1 DM 45% OF ALL MAJOR AMPUTATION CAUSED BY DIABETIC FOOT SYNDROME

3. INTRO………………. DEATH CAUSED OF FOOT DIABETIC 17- 32% GOOD DIABETIC FOOT CARE WILL DECREASE AMPUTATION IN ½ - ¾ CASES

4. DEFINITION OF DIABETIC FOOT SYNDROME FOOT ABNORMALITIES CAUSED BY NEUROPATHY, ANGIOPATHY AND INFECTION IN DIABETES MELLITUS PATIENT’S Infection NeuropathyIschemia

5. COMMON FOOT PROBLEMS HAMMER TOE CHARCOT JOINT HALUX VALGUS ULCER

6. INGROWN TOENAILS CORN & CALLUS

7. Peripheral vascular disease Peripheral neuropathy DM Increase flow regulation Shunting Reduced capillary blood flow motorsensoryAutonomic pain  proprioception  Power imbalance Deformity sweat  Fissuring  Defective response to start foot ulcer and infection

8. PERUBAHAN TEKANAN PADA KAKI MONOFILAMENT TEST

9. NEUROPATI DEEP TENDON REFLEX TEST TUNING FORK – VIBRATORY SENSE

10. ANGIOPATHY PULSASI ARTERI DORSALIS PEDIS

11. MANAGEMENT GOAL FOR DIABETIC FOOT ACUTE : WOUND HEALING SAFE THE FOOT FROM AMPUTATION CHRONIC : TO PREVENT RECURRENCY OF WOUND

12. GRADING ULCER (WAGNER CLASSIFICATION)

13. LEVEL I Neuropathy OBJECTIVE LEVEL II LEVEL III LEVEL IV Neuropathy+ Deformity Neuropathy + History of wound/amputation Neuropathy + bone disorganization No wound Wound free Treat the wound early No recurrent wound No amputation Wound free No amputation

14. Neuropathy Intervention and plan of treatment * General foot care * Appropriate foot wear Objective : No wound

15. Neuropathy + Deformity Intervention and plan of treatment * Foot care * Preventive surgery *Protective foot wear OBJECTIVE : WOUND FREE

16. Neuropathy + History of wound/amputation Objective: Treat wound early, no recurrent wound & no amputation Intervention and plan of treatment * Foot care *Treat the wound by off loading Tech. *Surgery (for complicated wound)

17. Neuropathy + Bone Disorganization Objective : Wound free & No Amputation Intervention and plan of treatment * Intensive foot care * Rehabilitation : a. Conservative treatment b. Reconstructive Surgery * Protective footwear

18. LONG TERM CARE TO PREVENT RECURRENT WOUND : * EDUCATION * DIABETIC FOOT CARE

19. DIFFERENTIATION OF THE FOOT HEALTHY FOOT Nerves let you feel pain, vibration, pressure, heat, and cold Blood Vessels Carry nutrients and oxygen to your feet to nourish them and help them heal from injuries. Bones give your foot shape and help distribute the pressure from your body's weight. Joints are the connections between your bones. They help absorb pressure and allow your foot to move. Your arch is a group of joints that provides stability for you entire foot DIABETIC FOOT Damaged Nerves  difficult to feel pain, pressure, heat and cold. Blocked Blood Vessels bring fewer nutrients and oxygen to feet  sores may not be able to heal. Weakened Bones may slowly shift, causing foot to become deformed and changing the way distributes pressure. Collapsed Joints, especially a collapsed arch, can no longer absorb pressure or provide stability. The surrounding skin may begin to break down.

20. DIABETIC FOOT CARE DIABETES REDUCES SENSATION WHICH CAN LEAD TO INJURIES Blisters or Calluses start as red or warm spots. They are often caused by unrelieved skin pressure Ulcers (sores) may result if blisters or calluses reach the skin's inner layers. Ulcers may become infected. Bone Infection may occur if infected ulcers spread. Untreated bone infections may lead to loss of foot.

21. DIABETIC FOOT CARE AND EDUCATION CHECK YOUR FEET EVERY DAY DO YOUR SEE RED SPOTS ? DO YOU HAVE BLISTERS OR CALLUSES ?

22. CARE AND EDUCATION IRRITATIONS, SKIN LESIONS BLISTER CUTS BETWEEN YOUR TOES

23. DO YOU FEEL TINGLING? ARE YOUR FEET COLD? ARE YOUR FEET NAILS INGROWN? HAS YOUR ARCH DECREASED?

24. TEST THE TEMPERATURE OF THE WATER BEFORE PUTTING YOUR FEET WASH YOUR FEET WITH LUKEWARM WATER AND MILD SOAP CARE AND EDUCATION

25. KEEP SKIN SUPPLE & MOISTURISED CUT YOUR NAIL CORRECTLY Do not cut the corner of your toe nails

26. CARE AND EDUCATION DO NOT WALK BARE FOOT

27. EXAMINE YOUR FEET DAILY DRY YOUR FEET PROPERLY DO NOT SOAK MORE THAN 5 MINUTES

28. DIABETIC SHOES

29. How To Select The Right Shoes?

30. GOOD DIABETIC SHOES…….. Both feet measures Deep and wide toes box Flexible rubber soles Cushioned insole, 0.5-1 cm thick and softness

31. GOOD DIABETIC SHOES….. Deep & wide enough to accommodate the foot A firm heel counter/Back strap Adjustable by laces/velcro fasteners to keep the shoe on the foot securely Acceptable to the patient in appearance, cost & function

32. TYPE OF FOOTWEAR Custom Molded Shoes With Insoles

33. TYPE OF FOOTWEAR Molded Sandal

34. WARNING SIGNS AND SYMPTOMS OF DIABETIC FOOT PROBLEMS

35. REMEMBER…… EXAMINE YOUR SHOES BEFORE PUTTING THEM ON DON’T ATTEMPT SELF TREATMENT SEEK IMMEDIATE MEDICAL ATTENTION

36. THANK YOU HATUR NUHUN

37. Type of Footwear Molded Insole 1. Increasing wt.bearing area 2. Assist the foot in normal function

38. Metatarsal bar

41. PATOGENESIS

42. DIABETIC FOOT LESION GRADING SYSTEM - WAGNER

43. MANAGEMENT