1

(Diabetic and Foot Care)

.. (APN)*

Maneerojjana,S.
Diabetic and Foot Care
TJN:(2007):(1-2) :
Keywords : Diabetic, Foot Care

"...


( )


...


... . "
( 16 .. 2548 )




Put Feet First Prevent Amputations

(Diabetic Foot)

( , 2549 ; , 2548 )


1. 10
2.
3.
4.
5.
6.


( ,2549 ; , 2548
; Lehto.S at et ,1996 )

1) (peripheral
neuropathy) 2) ( peripheral vascular disease) 3) ( foot stress)
4) (infection) ( , 2547 ; , 2548 ; ,
2548)
1.


1.1 (sensory neuropathy)




 3

1.2 (motor neuropathy)

(high
foot pressure)
1.3 (autonomic neuropathy)

2.


3.


3.1 ( high pressure penetrating injury )

3.2 (moderate - pressure repetitive injury )

(metatarsal head)


3.3 (low pressure continuous)

(claw toes)
(tip-top of toes)
4.


( , 2548 )





( , 2547 ; , 2458)
 4

1.

-
-
-
-
-
-
2.
2.1 ( neurological evaluation ) :
( peripheral neuropathy )

2.1.1 (motor)
( weakness and atrophy)
(intrinsic foot muscles) (ankle dorsiflexor)
2.1.2 (sensory)
(pinprick sensation) monofilament light touch
pressure semi quantitative test (sensitivity 0.84
1.00 , specificity 0.77-1.00) (Rith-Najarian & Stolusk, 1992 )
(Bell - Krotoski, 1991
, 2548 )
Semmes -Weinstein Monofilament
Semmes - Weinstien Monofilament
5.07 (10 gm)
(loss of protective sensation ; LOP)

-
monofilament

- 2

 5

- monofilament
monofilament
( 1)

- monofilament
monofilament "C" 1-2
( 2)

2 monofilament
( http: // www. medicalmonofilament.com )

- monofilament
monofilament
(+)
(-)
-

-
2.1.3 (autonomic) (dry)
( fissuring)
 6

2.2 ( vascular screening )

(shiny skin) (hair loss) ( low temperature) capillary
refill time ( 5 )
dorsalis pedis 2
posterior tibial ( , 2541)
2.3
(foot deformity) (bony prominence)
charcots neuroarthropathy (collapsed arch)
(abnormal gait patten) (limit joint motion) first
MTP ankle
2.4

2.5

4

0 ( low risk ) :
(no loss of protective)
monofilament 5.07 (10 gm.)

1
1 ( moderate risk ) :
( loss of protective sensation)
monofilament 5.07 (10 gm.) 1


 7

3 - 6

2 ( high risk ) :

/ ( loss of protective sensation & evidence of high pressure callus
, deformity or poor circulation)



1 - 3

3 ( very high risk ) :
( history of plantar ulceration or , charcot foot)

1 - 2 2

1. 2

2.

3.

 8

4. lanolin

5. /
6.



7.
8.
2 /


9.

10.
11.

12.

3

13.
14.

15.
16.
17.




 9

1.
-
-

-
velcro strap
-

-
-

-
-
metatarsal hard

2.

( )

-

-
2 2

- (heel-to-ball-fit)

- (ball width ) ( metatarsal head 1
5 )
-
3.
 10

-
-
- ( )


-

- 2 2

 11

(2548)
() :

(2458)
24 2548 .
. (2545) Diabetes Foot Ulcer.
2 :
. (2545) ( ) .
3 : .
(2548)
( ) :
. (2549) Diabetic foot. ( )
. 3 :
. (2546)
() :
. (2548) : 49 (3) : 173
187
. (2541) :

. (2547) .
() . 2 :

. (2546) .
() 1 :
. (2546) Diabetes Foot Ulcer ( )


. (2548)
() :
Abbott Ca., Vileikytel, Williamson S, et al. (1998 ) Multicenter study of the incidence and predictive
risk factor for diabetic neuropathic foot ulceration. Diabetes Care 21 : 1071.
American Diabetes Association (2000 ) : clinical practice recommendation 2000. Standards of medical
care for patients with diabetes mellitus. Diabetes Care 23 (suppl 1) : 32 47
 12

Lehto S.,Ronnemaa T., Pyorala K & Laakso M. (1996) Risk factors predicting lower extremity
amputations in patients with NIDDM. Diabetes Care 19 (6) :602 - 12
Mayfield JA, Reiber GE, Sanders LJ, Janisse D, Pogach LM.(1998) Preventive foot care in people with
diabetes. Diabetes Care 21 (12) : 2161 -77
Rith-Najarian SJ., Stolusky T. & Gohdes DM. (1992) Identifying diabetic patients at high risk for low-
extremity amputation in a primary health care setting. A prospective evaluation of simple
screening criteria. Diabetes Care 15 (10):1386-9.