Diabetes Statistics

1
(No Transcript)
2
(No Transcript)
3
(No Transcript)
4
DIABETES
5
Prevalence in Latino Culture2

• US Hispanic Americans are 1.8 times more likely
  to develop diabetes than non-Hispanic Americans.
• Colombia-2000 883,000 cases reported.
• Colombia estimates by 2030 2,425,000 cases.

6
(No Transcript)
7
Diabetes

• Condition where there is excess glucose levels in
  the blood
• Diabetes generally occurs when
• The body does not produce enough insulin, or
• The cells ignore the insulin produced (insulin
  resistance)

8
Types of Diabetes
Type 1 5-10 of Cases Type 2 90-95 of Cases
9
Types of Diabetes
10
Consequences

• The cells may be starved for energy.
• Eyes, kidneys, nerves, and heart may be affected.
  
• Increased risk of eye, heart, blood vessel,
  nerve, and kidney illness.

11
Foot Complications Resulting From Diabetes
12
The Foot
13
Diabetic Foot

• Neuropathy
• Dry skin
• Calluses
• Poor circulation

14
Amputations

• Diabetic patients are at a greater risk for foot
  or leg amputation.
• Reasons
• Poor circulation reduces blood flow to the feet.
• Nerve damage reduces sensation.
• These problems make it easy to get ulcers (open
  sores) and infections that may lead to
  amputation.
• Preventive measures
• Most amputations are preventable with regular
  care and proper footwear.

15
Charcots Foot

• Affects less than 8 of diabetics

16
Charcots Foot

• Caused by nerve damage
• bones become weakened and fracture
• muscles cannot support the body
• ligaments loosen, joints may become dislocated
• dislocation or fracture may go unnoticed, further
  injury may occur

17
Charcots Foot
Excessive dislocation in the tersometatarsal
joints
18
Charcots Foot

• Treatment
• main treatment ? rest and stabilization
• Total contact cast (TCC)
• relieves pressure, prevents further
  dislocation/injury
• cannot be removed ? replaced periodically 6-9
  months

19
Charcots Foot

• Treatment
• orthotics ? several types available, depending on
  condition
• stabilize foot
• redistribute weight
• provide comfort

20
C.R.O.W.
21
CROW

• Charcot Restraint Orthotic Walker (CROW)
• Provides stability
• Removable ? ideal for patients with foot ulcers
• Alternative to TCC

22
CROW WALKER CASTING

• The foot should be cast at 90o angle
• Foam mold covered with a plastic film is
  positioned under the patients foot.
• Patient should slightly extend their toes upward,
  providing a good foot arch for rocker support.
• The mold is analyzed to identify bony prominences
  and potential problem sites.

23
Total Contact Casts
24
Total Contact Casts

• Used to heal diabetic foot ulcers
• Protects the foot during the early phases of
  Charcots fracture/dislocation
• Matches the exact contour of the foot

25
Total Contact Cast

• Distributes weight along the entire plantar
  aspect of the foot.
• Reduces shear forces normally present between the
  foot and shoe.
• Produces shortened stride length and a decreased
  walking velocity.

26
Casting a TCC

• A thin dressing is applied over the ulcer.
• A thin layer of stockinet is applied, and
  protective cast padding placed between the toes.
• Cast padding (Webril) is wrapped up the limb.
• Secondary foam padding covers the toes at bony
  prominences on inner and outer side of the ankle.
  
• Plaster undercoat is applied to the foot and leg,
  completely encasing the toes and up the leg.
• The sole of the cast is molded to contours of the
  sole of the foot.
• These valleys are then filled in with plaster of
  Paris or other material, so that the sole is
  flat. The cast may be reinforced by fiberglass.
• If necessary, rocker-bottom sole is applied to
  relieve stresses from walking.

27
Total Contact Casts

• Casts are changed weekly or bi-weekly.
• Casting is continued until the ulcer is healed,
  and the foot is ready for appropriate footwear
  and orthotic treatment.
• In the case of Charcots foot, casting is
  continued until the patients fractures heal.

28
Total Contact Casts

• The patient and the doctor should check for the
  following
• The cast should fit the leg very tightly.
• A space of more than 1/4 inch between the cast
  and leg is too much.
• Dents, cracks and other damage to the cast.
• Damage to the cast can apply dangerous levels of
  pressure to the leg, which may go unnoticed by
  the patient.
• A smell coming from the cast.
• This could be a sign of infection underneath the
  cast.

29
Diabetes Orthotics
30
Diabetes Orthotics

• Types of Orthotics
• custom-molded shoes
• depth shoes
• Inserts
• shoe modification, etc.
• Custom shoe fit
• adjustable closures, flexibility
• shock absorption ? pressure diffusion, prevents
  tissue breakdown
• correct foot and lower extremity position,
  movement

31
Diabetes Orthotics

• Types of Orthotics
• Compromise ? cut-outs, divots
• absorbs shock, prevents pressure sores
• Depth-inlay
• allows room for toe deformities, insertion of
  insoles

32
Diabetes Orthotics

• Types of Orthotics
• Extra-wide
• leaves room for bunions/abnormalities
• Rocker sole
• reduces pressure under metatarsal heads
• reduces risk of ulcers from rigid first
  metatarsal joint

33
Orthotics Rockerfrom AZ AFO
Normal Shoe
90, 15 plantar flexion, 90, 10 dorsiflexion,
90
Rocker Sole
All positions 90
34
Rocker Sole

• Types of Rocker Orthotics

Heel
Healing
MPJ (Metatarsal Phalangeal Joint)
35
Rocker Sole

• Types of Rocker Orthotics

Ankle Joint
Met-Head (Metatarsal Head)
Lisfranc (Lisfranc Joint)
36
Adjustment/Fabrication

• Example Modification
• Separate sole
• Grind 1.5 channel into midsole
• Insert shank
• Cover with 0.125 1.5 crepe and sand down
• Cover with 1.5 Dacron tape (thermoplastic
  polymer)
• Replace sole

37
Transtibial Prostheses
38
Transtibial Prostheses

• Definition
• A substitute for the lower part of the leg
• Necessary due to an amputation below the knee
• Amputation is performed where neuropathy in the
  leg ends.

39
Description

• Socket
• Fits over the residual limb
• Usually made out of polypropylene
• Pylon
• Needs to be strong and rigid
• Made from titanium or aluminum to keep weight
  low
• Foot
• Needs to be rigid enough to support weight
  during plantar flexion

40
Requirements

• A transtibial prosthesis must
• Provide load bearing support
• Allow proper gait
• Be easy to put on and remove
• Allow for the option to still wear a shoe

41
Manufacturing (Pylon)

• Materials ? Titanium vs. Aluminum
• Pylon is die cast ()
• Titanium ? higher strength to weight ratio (),
  but is expensive due to high melt temp (-)
• Aluminum ? melts at 600C (), but lower
  strength/weight (-)

42
Manufacturing (Socket)

• The socket needs to fit the patients limb
  tightly, yet comfortably
• A mold is made of the patients amputated lower
  limb
• Plastic is heated and vacuum formed around the
  mold
• The plastic socket is then cut off the mold and
  trimmed for a comfortable fit

43
Manufacturing (Socket)
44
Fitting a Transtibial Prosthesis

• Patients need to wear a thin, elastic stockinet
  over the residual limb
• allows the skin to breathe and prevents tissue
  breakdown
• If pressure points exist, the socket can be
  locally heated and reformed.

45
References

• 1. type1diabetesbasics/type1diabetes.cfm.
• 2. .
• 3. .
• 4. .
• 5. ion-to-charcot- arthropathy/.
• 6. OM20SOLES.
• 7. .
• 8. e.jsp.
• 9. .
• 10. lth4u.com.sg/health4u/ endocrinology/Types_of_Dia
  betes_Mellitus.html.
• 11. Value.Capsulitis/qx/searchresults.htm.
• 12. .
• 13. ndex3.html.
• 14. n/jun2002charrette.htm.