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DiabeticFeet
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> Neuropathy - damage to small vessels supplying nerves Ischaemia - atherosclerosis in larger vessels (peripheral vascular disease) (usually neuropathy first then ischaemia worsens situation) yearly 5% diabetics develop a foot ulcer, a few of which end up with amputation ''Managment'' exam - do yearly shoes temp colour skin pulses (dorsalis pedis and posterior tibial) sensation (10g monofilament - test in 10 places on foot) 10 places - under big, middle, little toe back a bit on foot in line with three toes, further back on foot 2 places and one place on heel, one place on top of foot - if any of the sites aren't felt than the foot is neuropathic Monofilament - use at right angles to foot, bend it 1 cm and keep it there for 2-3 secs, can be used on 10 patients in one session and then has to be left for 24 hours to recover its buckleability ''ask'' - pain - exercise/rest, numbness/tingling, soreness/irritation, shoes, how do you look after - check footwear when putting on, don't walk barefoot, wash and moisturize feet daily, examine daily for irritation, cut nails straight, see chiropodist for calluses ''assess risk'' //low - educate and yearly check// //moderate// - any of - sensation, deformity, loss of pulse or vision - //chiropody every 1-3/12// //high// if previous ulcer, amputation, callus with neuropathy, pulseless or deformity, or pulseless and neuropathy - //chiropody by diabetic team and orthotic referral// active disease - painful neuropathy difficult to control - needs urgent referral to diabetic MDT - ulcer, osteomyelitis, charcots foot ''Ulcers'' //Neuropathic// - deep and painless, punched out edge, over bony prominence //Arterial// - painful with poor capillary return and cold foot, punched out edge, all over new ulcer needs assesment and treatment within 24hours by specialist MDT ''Osteomyelitis'' urgent care - diabetics, microbiologist, surgeons MRI more useful than Xray on which it takes time for changes to occur ''Charcots joint'' after 10-15 years of diabetes neuropathic and osteoporotic feet become deformed - maybe after minor unnoticed trauma early stage may be warm and red but not painful later on deformed with loss of plantar arch Rx - difficult - MDT, rest, immobilise, reduce weight bearing stress
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DiabeticComplications