英文糖尿病足課件

英文糖尿病足DiabeticFootCareMarianneMisiewicz,DPM,AACFASColumbia,MO英文糖尿病足STATISTICS24millionAmericanshavediabetes,approximately7%ofthepopulation(CDC2008)15-25%willdevelopulcersontheirfeet.20%ofdiabeticsadmittedtohospitalsbecauseoffootproblemsNearly$98billionspentannuallyfordirectandindirectmedicalcosts(1997).

O’Brien,JA,etal.“DirectMedicalCostsofComplicationsResultingfromType2DiabetesintheUS.”DiabetesCarevol21#7,July1998.英文糖尿病足STATISTICS625,000newcasesofdiabetes/year178,000deaths/yearfromdiseaseandrelatedcomplications.NearlyhalfofnontraumaticLEAcausedbydiabetes.Averageacutehospitalcostin1996forafootulcer9,910.5yearsurvivalrate~50%forBKA O’Brien,JA,etal.“DirectMedicalCostsofComplicationsResultingfromType2DiabetesintheUS.”DiabetesCarevol21#7,July1998.英文糖尿病足STATISTICS~50%ofdiabeticswithLEArequire2ndLEAwithin5yearsofinitialamputation.Oftenrequirecareoutsideofhospitalization(80%)including: Prostheticdevice Physicianvisits Woundcare/HomeHealthO’Brien,JA,etal.“DirectMedicalCostsofComplicationsResultingfromType2DiabetesintheUS.”DiabetesCarevol21#7,July1998.英文糖尿病足STATISTICSGreaterthan50%ofallnon-traumaticamputationsarediabetics0.5billiondollarsforhospitalandsurgicalcostsperyear5yearsurvivalrate~50%s/pamputation.英文糖尿病足STATISTICSDiabetesisthe4thleadingcauseofdeathbydiseaseintheUnitedStatesDiabeticsare2-4timesmorelikelytoexperienceheartdiseaseandstrokesIstheleadingcauseofESRDIstheleadingcauseofblindnessinadults>75y/o.英文糖尿病足英文糖尿病足Sussman,KE."TheDiabeticFootProblem-AFailedSystemofHealthCare?"DiabetesResClinPract1992;17:1-8~53%offamilyphysiciansreportedadherencetosemi-annualfootexamsforpatientswithTypeIIdiabetes~64%reportedadherencewithTypeIdiabetics.英文糖尿病足Sussman,KE."TheDiabeticFootProblem-AFailedSystemofHealthCare?"DiabetesResClinPract1992;17:1-8Fewerthan20%ofdiabeticpatientsareregularlygivenfootexaminationsbytheirprimarycarephysicians英文糖尿病足英文糖尿病足FOOTEXAMSkin&IntegumentVascularNeurologicalMusculoskeletalShoegear英文糖尿病足FOOTEXAMSkinandIntegumentA.ColorB.TemperatureC.TextureD.HairGrowthE.MoistureF.Lesions-location,size,type G.Conditionoftoenails英文糖尿病足英文糖尿病足FOOTEXAMVascularexamA.ColorB.CFTC.Varicosities/EdemaD.Pulses(DPandPT)英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足FOOTEXAMNeurologicalA.LighttouchB.Sharp-dulldiscriminationC.VibratoryD.ProprioceptionE.ProtectivesensationF.DTR英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足FOOTEXAMMusculoskeletalA.Generalappearance(grossdeformities)B.Musclestrength/functionC.MuscletoneD.ROM英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足FOOTEXAMShoeGearA.EverydayshoestyleB.DressshoestyleC.ExerciseshoesD.Shoeinserts/orthosesE.Specialshoeneeds英文糖尿病足SHOES英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足SUPPORTIVEDEVICES英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足COMMONFOOTAILMENTSANDTHEIRTREATMENTSToenailsCorns/CallusesXerosisBunions/Hammertoes/othermusculoskeletalproblems英文糖尿病足COMMONFOOTAILMENTSANDTHEIRTREATMENTSVasculardiseaseNeuropathyULCERATIONS英文糖尿病足TOENAILSOnychomycosis=FungalnailsOnychocryptosis=ingrownnailOnychogryphosis=thickened(Ram’shorn)nailOnycholysis=crumblynailOnychia/Paronychia=abscessed/infectednail英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足CORNS英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足CALLUSESLocationCauseTreatmentPrevention英文糖尿病足CALLUSESCAUSE=PRESSUREUsuallyabonyprominence英文糖尿病足英文糖尿病足CALLUSESMEASURESTOELIMINATEPRESSUREPOINTSPodiatricconsultationfordebridementShoemodifications,insoles,orthoticsElectivesurgeryondeformity英文糖尿病足英文糖尿病足HALLUXABDUCTOVALGUSAKA-BUNIONS英文糖尿病足英文糖尿病足HAMMERTOESHAMMERDIGITSYNDROME英文糖尿病足英文糖尿病足VASCULARDISEASEARTERIALDISEASE A.Largevessel B.Smallvessel C.MicrovasculatureVENOUSDISEASE A.Varicosities B.Venousstasis英文糖尿病足英文糖尿病足NEUROPATHYPERIPHERALSENSORYNEUROPATHYMOTORNEUROPATHYAUTONOMICNEUROPATHY英文糖尿病足PERIPHERALSENSORYNEUROPATHY“GloveandStocking”distributionParesthesiaAnesthesia英文糖尿病足MOTORNEUROPATHYWeakness,atrophy,footdropStructuraldeformities(iehammertoes,pescavus)英文糖尿病足AUTONOMICNEUROPATHYSympatheticFailure-microvasculardilationAnhidrosis英文糖尿病足英文糖尿病足ULCERATIONWAGNERCLASSIFICATIONFORDIABETICFOOTLESIONSGrade0–Noopenlesion(callusmaybepresent)Grade1–SuperficialUlcerGrade2–DeepUlcertoTendon,CapsuleorBone英文糖尿病足ULCERATIONWAGNERCLASSIFICATIONFORDIABETICFOOTLESIONSGrade3–DeepUlcerwithabscess,osteomyelitis,jointsepsisGrade4–LocalizedgangreneGrade5–Gangreneofentirefoot英文糖尿病足ULCERATIONSDESCRIPTIONSIZE(LxWxD)DURATIONLOCATIONDRAINAGE/INFECTIONODORBASE/RIM英文糖尿病足ULCERATIONSTREATMENTPROTOCOLGRADE0Propershoe/orthoticsEducationPalliativePodiatriccareProphylacticsurgeryPrevention英文糖尿病足英文糖尿病足英文糖尿病足ULCERATIONSTREATMENTPROTOCOLGRADE1AntibiotictherapyWoundcareRadiographsSurgerySameasGrade0英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足ULCERATIONSTREATMENTPROTOCOLGRADE3Hospitalize/IVabxAggressiveI&D/DebridementRadiograph/Bonescan/MRI–r/oOMMetaboliccontrolPlasticsurgicalclosureprn英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足英文糖尿病足CONCLUSIONPREVENTION–“CYA”Multidisciplinaryteam-coordinatedbyPCPPatienteducationDailyfootinspectionsbypatientShoegearchangesElectivesurgerytodecreaserisk英文糖尿病足英文糖尿病足References:O”BrienJA,etal.“DirectMedicalCostsofComplicationsResultingFromType2DiabetesintheUS.”DiabetesCare199821:7pp1122-8.Sussman,KE.“TheDiabetic