Management of Diabetic Foot :

From Internist View

Rizki Habibie
June 28, 2012
 Topics
1. Risk and Pathogenesis diabetic foot
2. Foot examination
3. Assessment diabetic foot
4. Diabetic foot treatment
 Epidemiologi
• Diperkirakan 15% penderita diabetes
mengalami ulkus pedis
• 7% - 20% yg mengalami ulcus pedis 
memerlukan amputasi
• Lebih dari 80%  dapat dicegah
• Lokasi tersering :
– Ibu jari 51%
– Metatarsal : 28%
– dorsum pedis : 14%
– multiple : 7%
Risk factors for amputation
Contributing factors in the pathogenesis of ulceration.
Pathogenesis of diabetic foot infection
triangle of devil

Infection

Bad sensation Bad perfusion

Tekanan plantar kaki waktu berjalan org
normal
Tekanan plantar kaki waktu berjalan org
normal
Hitam : normal
Abu-abu : diabet non neuropati
Putih : diabet neuropati
 Topics
1. Risk and Pathogenesis diabetic foot
2. Foot examination
3. Assessment diabetic foot
4. Diabetic foot treatment
 FOOT EXAMINATION
1. Vascular
2. Neurologic
3. Musculosceletal
4. Dermatologic
5. Foot wear
1. Vascular Examination
2. Neurologic Examination
Neurologic Examination
• The patient is asked to say "yes" each time he or she feels the filament.
Failure to feel the filament at four of 10 sites is 97 percent sensitive and 83
percent specific for identifying loss of protective sensatio
3. Musculoskeletal Examination
Hammertoes
4. Dermatologic Examination
5. Footwear Examination
 Topics
1. Risk and Pathogenesis diabetic foot
2. Foot examination
3. Assessment diabetic foot
4. Diabetic foot treatment
Assessment objectives for foot ulcerations
Wagner Clasification (wound)
University of Texas Wound Classification System
Lipsky et al, 2012
 Topics
1. Risk and Pathogenesis diabetic foot
2. Foot examination
3. Assessment diabetic foot
4. Diabetic foot treatment
 Tatalaksana
1. Kontrol Metabolik
 Koreksi hiperglikemia
 Perbaiki nutrisi
 Periksa kadar albumin, termasuk DL
2. Kontrol Vaskular
 Aspirin  boleh tetapi bukti kurang kuat
 Debridement
 Revaskularisasi – PTCA
3. Kontrol Infeksi / Mikrobiologi
 Rawat luka – dressing
 Antibiotika  peta kuman
Lipsky et al, 2012
Lipsky et al, 2012
Lipsky et al, 2012
Lipsky et al, 2012
Lipsky et al, 2012
Lipsky et al, 2012
4. Kontrol Mekanik (Non weight bearing)
 Removable cast walker
 Temporary shoes
 Crutches
 Wheelchair
 Dekompresi ulkus/abses
 Operasi ( Hammer toe, metatarsal head
resection, partial calcanectomy dll)
5. Kontrol Edukasi
Total contact cast
 Faktor – faktor yang mempengaruhi
prognosa
1. Vaskular : Atherosklerosis, thrombus
2. Neurologis : Neuropati
3. Infeksi : Debridement inadequat, infeksi
polimikroba, osteomyelitis, fx neutrofil ↓
4. Imunosupresi
5. Mekanik : edema, weight bearing
6. Nutrisi : albumin ↓
7. Pasien : kepatuhan
8. Terlambat periksa dan terapi