DR JAYESH KAKAR DR JAYESH KAKAR DR JAYESH KAKAR DR JAYESH KAKAR Consultant Diabetic Foot & Peripheral Vascular Surgeon SAVE LEGS CLINIC SAVE LEGS CLINIC TEL : 9966668283 TEL : 9966668283 www.savelegs.com Hon Consultant : Hyderabad Hon Consultant : Mumbai Hon Consultant : Hyderabad Global Hospitals, Mahavir Hospital Hon Consultant : Mumbai Breach Candy Hospital BSES MG Hospital
About the Global Burden of Foot Problems, especially Diabetic foot
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SAVE LEGS CLINICSAVE LEGS CLINICTEL : 9966668283TEL : 9966668283
www.savelegs.com
Hon Consultant : HyderabadHon Consultant : Mumbai Hon Consultant : Hyderabad Global Hospitals, Mahavir Hospital
Hon Consultant : MumbaiBreach Candy Hospital
BSES MG Hospital
WHY THE NAME ?
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AIMS :
After a thorough Clinical, Radiological & Orthotic Evaluation of patients, we aim to achieve the BEST in
•LEG CONSERVATION
•AMPUTATION PREVENTION
•REHABILITATION OF PATIENTS
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THE CLINIC IS DEDICATED TO THE PREVENTION & TREATMENT OF
LOWER LIMB DISORDERSLOWER LIMB DISORDERS
TREATMENT
INVESTIGATIONS
PREVENTIVE CARE & REHABILITATIONPREVENTIVE CARE & REHABILITATION
FOOT AIDS like CUSTOMIZED FOOTWEAR, MEDICAL COMPRESSION STOCKINGS INSOLES and otherCOMPRESSION STOCKINGS, INSOLES, and other PODIATRIC AIDS
Are available for the FIRST time under one ROOF, for ,MAXIMUM CARE & CONVENIENCE OF PATIENTS.
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EVEN THOUGH WE TREAT MOST FOOT & LEG PROBLEMS
THE FOCUS OF THIS PRESENTATION WILL BE ON SOME OF THE COMMONEST PROBLEMS
PICTORIALS, GRAPHICS & TEXT
AIM IS TO SPREAD AWARENESS - WITH THE SCIENCE OF LEG SALVAGE & PODIATRY, IT IS TODAY POSSIBLE TO SAVE LIMBS & CURE LEG PROBLEMS THAT A FEWTO SAVE LIMBS & CURE LEG PROBLEMS THAT A FEW YEARS BACK WERE CONSIDERED EITHER CHRONIC OR INCURABLE
•Every 10 Seconds a person dies of Diabetes Related Mortality
•Every 10 Seconds 2 People develop Diabetesy p p
•Upto 25% of Family Income may go towards Diabetes care in Low Income Indian Families
•India has the World’s LARGEST Diabetes population
•40 % of admissions of Diabetic Patients are due to FOOT40 % of admissions of Diabetic Patients are due to FOOTProblems
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Diabetic foot
15% of diabetics experience serious foot pproblems.They are the leading cause of hospitalizations y g pfor these patients.
DIABETES IS THE LEADING CAUSE OFNON TRAUMATIC LOWER LIMB AMPUTATIONS – 50-70%
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2006 FIGURES2006 FIGURES
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DIABETIC FOOT
THIS TERM WOULD NORMALLY EVOKE ONE OF THE FOLLOWING PICTURES :FOLLOWING PICTURES :
LEADING TO THISTO THIS
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IGNORANCE IS BLISSIGNORANCE IS BLISS
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Diabetes & Foot Check UpDiabetes & Foot Check Up
NEUROTHESIOMETER C W DOPPLER To MeasureNEUROTHESIOMETER To Detect Nerve Damage
C-W DOPPLER To Measure Blood Supply to the Feet
DIABETICS MUST GET THEIR FEET CHECKED ONCE AN YEAR TO AVOID FOOT COMPLICATIONS
SAVELEGS.COMSAVELEGS.COM*Report of the The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997;20(7):1183-1197.
DIAGNOSISDIAGNOSIS
•BURNING/TENDERNESS/NUMBNESS IN THE FEET
•LOSS OF BALANCE
•SHARP PAINS OR CRAMPS
•FEELING OF ‘SOMETHING’ UNDER THE FOOT
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COMMON FOOT PROBLEMS IN DIABETICS
•Infection •Pus formation•Ulcerations•Gangrenei h f fin the feet of long standing diabetics.
Ulcer- Common SIGHT & Site in Diabetic Patients
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GangreneGangrene
Toe Gangrene Heel Gangrene
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Varicose VeinsTender soft knots or winding veins in the calf
or leg that are worse after standing for long
periodsperiods.
May also present as aching
& swollen legs at the end
of the day.
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TREATMENT
SURGERYSURGERYSURGERYSURGERYMOST PATIENTS WITHOUT COMPLICATIONS CANMOST PATIENTS WITHOUT COMPLICATIONS CAN BE MANAGED AS DAYCARE OR SHORT TERM(1-2 DAYS) STAY CASESDAYS) STAY CASES
LASER TREATMENT
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Chronic Venous InsufficiencyECZEMA AND SKIN CHANGESECZEMA AND SKIN CHANGESA form of eczema can occur in the calf, sometimes over an area of varicosity. The skin is red and itchy.over an area of varicosity. The skin is red and itchy. Areas of the calf and around the ankle may develop a brown stain in the skin. b ow sta t e s .
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WHO GETS VENOUS PROBLEMS ?
1. HEREDITARY – 50%2. PEOPLE STANDING/SITTING AT WORK FOR LONG
PERIODS e.g. TEACHERS, NURSES, POLICEMEN, BUSPERIODS e.g. TEACHERS, NURSES, POLICEMEN, BUS CONDUCTORS etc.
WHAT WORSENS IT ?
1. SMOKING2. OVERWEIGHT
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COMMON SYMPTOMS OF VENOUS
1 H i t i i th l
PROBLEMS1.Heaviness or tension in the legs.
2.Swelling or Feeling of swelling ALL SYMPTOMS TEND
in the legs- especially around the
ankles.
TO INCREASE IN THE EVENINGS OR AFTER STANDING FOR LONG PERIODS AND
3.Itching or tingling.
4.Burning Sensation in the legs.
PERIODS AND DECREASE WITH LEG ELEVATION
4.Burning Sensation in the legs.
5.Cramps.
6 Restless/Tired legs6.Restless/Tired legs
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COMPLICATIONS OF VENOUS DISORDERS
•HAEMORRHAGE (Bleeding)
•THROMBOPHLEBITIS
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SKIN CHANGES : - Darkening of the Skin due to S C G S gPIGMENTATION
•VENOUS ULCERSVENOUS ULCERS
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Peripheral Vascular Disease Arterial ProblemsP i i th lPain in the legs on
walking (relieved by g ( y
rest)
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NON HEALING ULCERS IN THE LEG AND FEETNON HEALING ULCERS IN THE LEG AND FEET
More common in diabetics, smokers, the obese or people with a family history of atherosclerotic disease.p p y y
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Heel SpurPresents as a sharp pain in the centre of the heel worse in the morning and begins toheel, worse in the morning and begins to lessen as you begin to walk.
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INGROWN TOE NAIL
A toenail which appears to beA toenail, which appears to be abnormally shaped and repeatedly keeps getting i f t d d di h iinfected and discharging pus or a watery discharge tinged with blood.
CORNS & CALLOSITIESCORNS & CALLOSITIESThickened and painful areas of skin.
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FOOT DEFORMITIES
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DEFORMED FOOT DUE TO DIABETES
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BUNION Outward deviation Of the Great Toe
HAMMER TOES
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BUNIONS &BUNIONS & ULCERS > 5YRS IN A DIABETIC
4 MONTHS AFTER SURGERYSURGERY
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FOOT ULCER 20 YRS DURATION
3 MONTHS AFTER TREATMENTTREATMENT
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HEEL ULCER WITHHEEL ULCER WITH PVD WITH DIABETES > 6-7 YRS
• FOOT MODIFICATION TO PREVENT C C A ORECURRENT ULCERATION
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Ischemic ulcerationIschemic ulceration
Hair loss
P ll /C i /R bPallor/Cyanosis/Rubor
Muscle atrophyp y
Smooth, shiny skin, ed skin t ttemperature
Edema
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VASCULAR BYPASS VASCULAR BYPASS SURGERYSURGERY
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OTHER MODALITIES
HBO
PROSTAGLANDINS
MAGGOT THERAPY
HONEYHONEY
ULTRASOUND ETC
HAVE NO WELL DEFINED ROLE BUT MAY BE USED INHAVE NO WELL DEFINED ROLE BUT MAY BE USED IN SELECTED/RESISTANT CASES AT THE DISCRETION OF THE TREATING PHYSICIAN