ueda2013 prevention of amputation-d.mamdoh

1. Prevention of amputation in
diabetes:A fact or fiction
Mamdouh El-Nahas
Professor and the Head of Diabetes and Endocrinology Unit,
Mansoura University
Chairman of the Egyptian Society of Diabetic foot

2. Gangrene is
the most
devastating
complication
of diabetes

3.  Up to 70% of all leg amputations happen to
people with diabetes.
 Every 30 seconds a leg is lost to diabetes
somewhere in the world.

4.  Of all late complications of diabetes, foot problems
are the easiest to detect.
 Relatively simple interventions can reduce
amputations by 50 - 80%. (Bakker et al 1994).

5. However, DF complications are
still neglected

6. The term Diabetic Foot is usually used to
indicate advanced foot pathology

7. Gangrene
Advanced Foot
Pathology
High Risk Foot
Low risk Foot

8. Gangrene
Advanced Foot Pathology

9. Advanced foot Pathology
 Diabetic Foot ulcers
 Diabetic foot Infections
 Charcot foot
 Critical limb ischemia

10. DFUs
Neuropathic Neurischemic Ischemic

11. Neuropathic Ulcer

12. Ischemic ulcers

13. Gangrene
Advanced Foot Pathology
High Risk Foot

14.  Peripheral sensorimotor neuropathy
 Peripheral vascular disease
 Altered foot biomechanics
 History of foot ulceration or lower limb
amputation
 Deformity
 Trauma
 Skin and Nail pathology
 Nephropathy and renal dialysis
Risk factors for advanced foot
pathology

15.  Peripheral sensorimotor neuropathy
 Peripheral vascular disease
 Altered foot biomechanics
 History of foot ulceration or lower limb
amputation
 Deformity
 Trauma
 Skin and Nail pathology
 Nephropathy and renal dialysis
Risk factors for DFUs

17.  Peripheral sensorimotor neuropathy
 Peripheral vascular disease
 Altered foot biomechanics
 History of foot ulceration or lower limb
amputation
 Deformity
 Trauma
 Skin and Nail pathology
 Nephropathy and renal dialysis
Risk factors for DFUs

18.  A major risk factor for lower-extremity
amputation, especially in patients with diabetes.
 A marker for systemic vascular disease.

19.  Peripheral sensorimotor neuropathy
 Peripheral vascular disease
 Altered foot biomechanics
 History of foot ulceration or lower limb
amputation
 Deformity
 Trauma
 Skin and Nail pathology
 Nephropathy and renal dialysis
Risk factors for DFUs

21.  Peripheral sensorimotor neuropathy
 Peripheral vascular disease
 Altered foot biomechanics
 History of foot ulceration or lower limb
amputation
 Deformity
 Trauma
 Skin and Nail pathology
 Nephropathy and renal dialysis
Risk factors for DFUs

22. History of previous foot ulceration or lower limb
amputation are the strongest risk factors to the
recurrence of ulcers in diabetic patients

23.  Peripheral sensorimotor neuropathy
 Peripheral vascular disease
 Altered foot biomechanics
 History of foot ulceration or lower limb
amputation
 Deformity
 Trauma
 Skin and Nail pathology
 Nephropathy and renal dialysis
Risk factors for DFUs

25.  Peripheral sensorimotor neuropathy
 Peripheral vascular disease
 Altered foot biomechanics
 History of foot ulceration or lower limb
amputation
 Deformity
 Trauma
 Skin and Nail pathology
 Nephropathy and renal dialysis
Risk factors for DFUs

27.  Peripheral sensorimotor neuropathy
 Peripheral vascular disease
 Altered foot biomechanics
 History of foot ulceration or lower limb
amputation
 Deformity
 Trauma
 Skin and Nail pathology
 Nephropathy and renal dialysis
Risk factors for DFUs

29.  Peripheral sensorimotor neuropathy
 Peripheral vascular disease
 Altered foot biomechanics
 History of foot ulceration or lower limb
amputation
 Deformity
 Trauma
 Skin and Nail pathology
 Nephropathy and renal dialysis
Risk factors for DFUs

30.  Patients with all stages of diabetic nephropathy
were found to have an increased risk of DFU.
 The introduction of a podiatry service into a
dialysis unit resulted in a prompt and significant
reduction in the incidence of amputation in the
space of just 1 year (McMurray et al 2002).

31. Gangrene
Advanced Foot
Pathology
High Risk Foot
Low risk Foot

32. How to prevent amputation in
diabetic subjects?

33. To prevent amputation, we should diagnose
and treat any mild foot pathology before
its progression into advanced foot
pathology

35. Low Risk Foot
High Risk Foot
Advanced Foot
Pathology
Gangrene

36. A simple plan to prevent amputation (IWGDF)
Regular inspection and examination of the foot.
Identification of the foot at risk.
Education of patient, family and healthcare
providers.
Appropriate footwear.
Treatment of non ulcerative pathology

37. A simple plan to prevent amputation (IWGDF)
Regular inspection and examination of the foot.
Identification of the foot at risk.
Education of patient, family and healthcare
providers.
Appropriate footwear.
Treatment of non ulcerative pathology

38. The low tech high touch approach

39. A simple plan to prevent amputation (IWGDF)
Regular inspection and examination of the foot.
Identification of the foot at risk.
Education of patient, family and healthcare
providers.
Appropriate footwear.
Treatment of non ulcerative pathology

40. Category
Risk profile
Check-up frequency
0
No sensory neuropathy
once a year
1 Sensory neuropathy once every 6 months
2 sensory neuropathy and signs
of peripheral vascular disease
and/or foot deformities.
once every 3 months
3 previous ulcer or amputation once every month

41. A simple plan to prevent amputation (IWGDF)
Regular inspection and examination of the foot.
Identification of the foot at risk.
Education of patient, family and healthcare
providers.
Appropriate footwear.
Treatment of non ulcerative pathology

42. WWW.ESDF.me

45. A simple plan to prevent amputation (IWGDF)
Regular inspection and examination of the foot.
Identification of the foot at risk.
Education of patient, family and healthcare
providers.
Appropriate footwear.
Treatment of non ulcerative pathology

47. A simple plan to prevent amputation (IWGDF)
Regular inspection and examination of the foot.
Identification of the foot at risk.
Education of patient, family and healthcare
providers.
Appropriate footwear.
Treatment of non ulcerative pathology

56. In shoe
plantar
pressure
before CMI

57. In shoe
plantar
pressure
after CMI

58. Conclusions

59. To prevent amputation in Diabetes
Put feet first prevent amputation

60. Superior doctors prevent the disease
Mediocre doctors treat the disease
before evident
Inferior doctors treat the full-blown
disease
Huang Dee, China, B.C. 2600

61. Thank you