Hafna’s file, 2013 Pathophysiology of Diabetic Foot Ulcer

FOOT AND DIABETIC WOUND

MANAGEMENT
• Oleh:
• Ns. Hafna Ilmy Muhalla, S.Kep., M.Kep., Sp.Kep.M.B.

• One of diabetic chronic complication

• 12-25% diabetic patients are having DFU
• In Indonesia 15% DFU, 80% in hospital
• 40%-70% caused amputation, 85% amputation are with DFU firstly
• Every 30 second amputation is occur
• Need cost: 1.3-1.6 million a month and 43,5 million a year (Hastuti, 2008)

Decreased productivity
Self concept disturbance
Decreased quality of life

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DFU problematic
Delay handling: DIABETIC FOOT MANAGEMENT
HOPE????
Didn’t know Limitations 5 cornerstones of foot management
Fear Financial
Culture 1. Foot examination
Ignore
regularly
Negligent
2. Identification of 4. Treatment before
risk factors Ulcer occur

3. Education 5. Used an
(patients, providers Appropriate footwear
and family)

As an early detection and prevention

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1. Daily foot examination FOOT SKIN

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5

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Diabetic foot management… 1) foot examination 9

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 NAIL FOOT DEFORMITIES

Atrophy/distrophy Thickening Onikomicosis

Bunion/
Hammer Toes Claw Toes Hallux Valgus
Charcot toes

In growing nail Infection

Onychogryphosis Pes Cavus Post amputation/surgery
Diabetic foot management… 1) foot examination… inspection Diabetic foot management… 1) foot examination… inspection

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EDEMA
VASCULAR EXAMINATIONS
ABI (Ankle Brachial Index)

Toe Pressure

Transcutanious
NECROSIS AND INFECTION
Diabetic foot management… 1) foot examination… inspection
Oximetri
Diabetic foot management… 1) foot examination… specific measurement

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NEUROLOGICAL EXAMINATIONS NEUROLOGICAL EXAMINATIONS

(Pain, Term, Touch, Pressure) (Vibration and Position Sense)
Tuning Fork/Garputala 128 Hz Propioception

Biothesiometer
AbN: >25V

Pain: Pin Prick Test Pressure: Up position

Distal phalanx of the great toe
Monofilamen 10 guage

Touch: Wol/Cotton

Term: Metal Rods

Down position
Diabetic foot management… 1) foot examination… specific measurement Maleollus Diabetic foot management… 1) foot examination… specific measurement

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 Tendon Reflex 2. IDENTIFICATIONS OF RISK FACTORS

a. PHERIPERAL NEUROPATHY b. PERIPHERAL ARTERIAL

SENSORIC
DISEASE
MOTORIC OTONOM

Jendrassik Maneuver

Achilles
c. RIWAYAT GANGREN
d. OBESITAS ✓ Correlated with
atherosclerosis
Patella f. DEFORMITAS KAKI ✓  A1C 1 % - 26 % PAD
g. PERTUMBUHAN KUKU ABNORMAL ✓ More aggressive
✓ Narrowing vessel lumen …
h. KONTROL GULA DARAH BURUK obstructive
✓ Distal tissue necrosis
Diabetic foot management… 1) foot examination… specific measurement Diabetic foot management… 2) identification of risk factors

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DIABETES CONTROL
i. INAPPROPRIATE SOCKS and FOOTWEAR 3. EDUCATION
DFU RISK FACTOR
FOOTWEAR EDUCATION

Dietary management Blood Pressure Control

Proper Medication Use Foot Care Practice

Blood Glucose Check

Physical activity

Dental Care and

Diabetic foot management… 3) education Hygiene
Diabetic foot management… 2) identification of risk factors

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4. TREATMENT BEFORE ULCUS FOOT WASH, SKIN CARE

OCCUR
• Foot Wash • Skin Care
FOOT EXAMINATION

Bruises, cracked, moist, crumbly,

dry, swollen, bulla, sharp nail, in
growing nail, feel hot or cold • Every day (+)
• Water + soap (+) • Foot moisturize (+)
• Check the water with a • Powder (-)
thermometer or elbow • Finger sidelines (-)
(+) max 37°C • Moisturize 2x/day (+)
• Dry your feet (+) • An alcohol cream (-)
• Light colored towels (+)
• Call the doctor if there
are any abnormalities (+)
• Soak feet (-)
Diabetic foot management… 4) treatment before ulcer occur Diabetic foot management… 4) treatment before ulcer occur

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