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FOOT
DR.SEIF I M ELMAHI
MD, FRCSI
University of Khartoum,
Sudan
CONTENT
Definition
Epidemiology
Social & Economic factors
Pathophysiology of foot ulceration
Diabetic Neuropathy
Peripheral Vascular Disease & Diabetes
Biomechanics of Foot Wear
The Diabetic Foot Ulcer Outcome & Management
Neuro-osteoarthropathy
Amputation in Diabetic Patient
Prevention of Foot Problem
Diabetic Foot
Definition:
Infection, ulceration or
destruction of deep tissues associated
with neurological abnormalities &
various degrees of peripheral vascular
diseases in the lower limb
definition)
(based on WHO
Epidemiology
40%
Epidemiology
In Sudan:
Prevalence of DM ? 6 12 %
DSF inpatient KTH :
30% - 40% risk of major
amputation
8% - 20% mortality
Intervention
63000USD)
(4 weeks dressing cost 110000SD)
Neuropathic
Ischemic
Neuro -ischemic
Diabetic Neuropathy
Sensorimotor
& peripheral
sympathatic neuropathy are major
risk factors for ulcer
History & careful foot examination are
mandatory to diagnose neuropathy
Up to 50%of type2 diabetic patient
have significant neuropathy & at risk
of foot ulcer
Neuro-osteoarthropathy
Non-
infective pathology
Should be suspected in any swollen
hot erythematous foot
Differentiation from infection is
important to prevent misdiagnosis &
possible amputation
Treatment should aim at preventing
severe deformity
approach
Staging dictate the treatment
option
Continuity of care & life long
observation
minor\major amputation
increased the no. of deformed feet
Minor amputation is needed :
*Gangrene
*As part of debriment
*for correction of foot deformities
Minor
amputation doesnt
significantly compromise walking
ability
Major Amputation
SENSORY NEUROPATHY
Diabetic Neuropathy
FOOT WEAR
FOOT WEAR
OSTEOMYLITIS
control
control
Vascular control
Mechanical control
Metabolic control
Educational control
Clinical condition
Normal
High risk
Ulcerated
cellulitic
Necrotic
Major
breakdown
Infection
Necrosis
NEURO-OSTEOARTHROPATHY(CHARCOT
FOOT)
NEURO-OSTEOARTHROPATHY(CHARCOT
FOOT)Neuro-osteoarthropathy
PODIATRY