DIABETIC FOOT ULCERS AND INFECTION: IT S NOT WHAT YOU PUT ON AN ULCER THAT HEALS AN ULCER. IT S WHAT YOU TAKE OFF

Size: px
Start display at page:

Download "DIABETIC FOOT ULCERS AND INFECTION: IT S NOT WHAT YOU PUT ON AN ULCER THAT HEALS AN ULCER. IT S WHAT YOU TAKE OFF"

Transcription

1 DIABETIC FOOT ULCERS AND INFECTION: IT S NOT WHAT YOU PUT ON AN ULCER THAT HEALS AN ULCER. IT S WHAT YOU TAKE OFF Dr Bill Thompson Associate Professor of Medicine Schulich School of Medicien and Dentistry Western University October, 28, 2016 OBJECTIVES To understand the changes in the feet of diabetics that lead to foot ulceration To be able to identify a foot at risk To be able to manage an infected or non infected foot ulcer Initial evaluation General principles Who do you ask for help? 1

2 THESE FEET WERE MADE FOR WALKING THE DIABETIC FOOT AND NEUROPATHY The diabetic foot is prone to ulceration from neuropathy because of Loss of sensation Loss of motor power Development of abnormal blood flow All of the above None of the above 2

3 NEUROPATHY ASSESSMENT MONOFILAMENT TEST NORMAL FOOT STRUCTURE UGisEC_9IZU/T01gA3ObHRI/AAAAAAAAAS8/I1a 8b3FY_LY/s1600/foot-muscles.jpg 3

4 MRI OF FOOT 4

5 5

6 WHAT IS THE COMMON FEATURE FOR THESE ITEMS? 6

7 OTHER SHOE RELATED INJURY Slip sliding away Bad wear pattern Narrow shoe with inadequate toe box No real protection here but most common in house foot wear IF THE SHOE DOESN T FIT 7

8 PROGRESSION OF A FOOT ULCER MARCH 20,2016 PROGRESSION OF A FOOT ULCER APRIL 11 JUNE 29 SEPT 19 8

9 WHY THE DIABETIC FOOT GETS INFECTED Neuropathy sensation Motor weakness Deformity Trauma Compressive Shear stress Shoes (50%) Environmental Ulcer Infected ulcer Bacteria colonize & invade Vasculopathy proximal distal Impaired Cell Function glucose neutrophils ANATOMIC LOCATIONS AND TYPES OF ULCERS In the following slides consider which of the ulcers are infected and whether you would give antibiotics 9

10 ANATOMIC LOCATIONS AND TYPES OF ULCERS Paronychia Dropped metatarsal heads and damaged 1 st MTH Rocker bottom Charcot foot ulcer Hammer toe ulcer ANATOMIC LOCATIONS AND TYPES OF ULCERS Time heals all wounds In the diabetic foot. Time wounds all heels 10

11 ANATOMIC LOCATIONS AND TYPES OF ULCERS Stiff MTP joint (Hallux rigididis) INFECTION 50% of DFUs become infected during management (Lipsky BA, et al. 2006) 90% amputations preceded by infection (Pecoraro RE et al, 1990) Diagnosis Based on clinical symptoms and signs. No diagnostic test available to diagnose infection. Other tests used to guide clinical treatment NOT to help diagnose Lipsky, B. A., Berendt, A. R., Deery, H. G., Embil, J. M., Joseph, W. S., Karchmer, A. W., et al. (2006). Diagnosis and treatment of diabetic foot infections. Plastic and Reconstructive Surgery, 117(7 Suppl), 212S-238S. 11

12 DIAGNOSING INFECTION Infection should be diagnosed clinically on the basis of the presence of at least 2 of the cardinal manifestations of inflammation Purulent exudate, redness, warmth, swelling or induration, and pain or tenderness Lipsky B, et al, 2012, 2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections FOOT ULCER AND INFECTION IN DM Factors promoting infection include: type, depth, and location of the ulcer; tissue perfusion; and the integrity of the host immune response. Impaired sensory nerve function (neuropathy) delayed and attenuated inflammatory response Not dysfunction of microvasculature, rather dysfunction of response to tissue damage Therefore, signs & symptoms of infection are reduced in 1/2 PWD may just be in pain or exudate or size or smell difficult to judge Other signs may indicate infection.. 12

13 SEVERE INFECTION 50% of patients with a limb-threatening infection do not manifest systemic signs or symptoms Requires immediate hospital admission and surgical intervention Life / limb threatening This patient presented to emerg after having the ulcer for three months. She was wrapping it with facial tissues. She removed the proximal phalanx when the bone poked through the ulcer MICROBIOLOGY OF DIABETIC FOOT INFECTIONS Most infections are polymicrobial Aerobic Gm + cocci (S. aureus, B-hemolytic Streptococci) most common Aerobic gram negatives important co-pathogens in chronic wounds or after antibiotics Anaerobes co-pathogens in ischaemic or necrotic wounds 13

14 ASSESSMENT OF THE DIABETIC PATIENT S FOOT FOR RISK OF/OR ULCERATION NEUROPATHY ASSESSMENT MONOFILAMENT TEST 14

15 VASCULAR ASSESSMENT ANKLE BRACHIAL INDEX IDSA Interpretation of ABI s >1.3: Poorly compressible arteries, vascular calcification : Normal : Mild arterial obstruction Moderate arterial obstruction < 0.4: Severe arterial obstruction ABI < 0.6 indicates poor healing potential ASSESSMENT OF FOOT TEMPERATURE Infrared laser thermometer Uses A difference of 2 o C or 5 o F is suggestive of infection when compared to same site other foot all other factors being equal Useful in monitoring activity of acute charcot foot Development of temperature difference shows an increased risk for the development of a foot ulcer 15

16 WOUND SWAB Effective in antibiotic naïve wounds Swabs less able to identify pathogenic organisms in wounds with: a longer wound history, or recurrent wound and In those patients who have been treated in hospital Guidelines recommend prescribing antibiotics empirically in antibiotic naïve wounds Is it really necessary to do a swab, when realistically, we know what the treatment will be anyway? Culturing prior to antibiotics if admitted to hospital benificial However: In certain circumstances swabs may be the only available method Better than nothing LEVINE S TECHNIQUE Gently debride and clean the wound Can use normal saline to wash Avoid swabbing undebrided ulcers or wound drainage. use a swab designed for culturing aerobic and anaerobic organisms Select area near center of wound, free of necrosis and debris Rotate swab over 1 cm 2 area for 5 seconds applying pressure to extract fluid (90% sensitivity & 57% specificity) Need to transport specimens to the laboratory: promptly, and in suitable transport media. Gardner et al (2006) Lipsky et al (2006) 16

17 WOUND BED TISSUE SCRAPING Wound swabs poorly correlated to pathogenic organisms in these cases Swabs take the superficial organisms wound contains many organisms unlikely to capture the actual infective organism Wound bed tissue scrapings more sensitive Used to identify pathogenic organisms NOT to diagnose infection Clinical signs and symptoms used to diagnose Lipsky B et al (2006) How to take a specimen? Before obtaining specimens for culture Cleanse and debride the lesion Obtain tissue specimens from debrided base by: curettage (scraping with sterile dermal curette or scalpel blade), (Level of evidence A-I), or biopsy (bedside or operative) (Level of evidence A-I). Clearly identify samples specimen type and anatomic location Promptly send them to the laboratory for aerobic and anaerobic culture in an appropriate sterile container or transport media 17

18 TAKING THE PRESSURE OFF Antibiotics covering Staph and Strep, gram negatives Keflex Clavulin Levofloxacin If concerned about anaerobes add metronidazole or use clavulin In dialysis patient culture if possible as higher risk for resistant gram negatives or MRSA DRESSINGS Goal is to keep surface of wound with about the same moisture content as the surface of your eye Any antibacterial dressing is as good as another provided the pressure is taken off the wound and the dressing is changed often enough to keep the moisture level appropriate 18

19 OFF LOADING OPTIONS Silicone rubber buttress for toe ulcers OFF LOADING OPTIONS Hapla felt to foot Sequential layers of 10mm compressed felt Applied directly to foot Aperature left over wound to allow for dressing changes. Tape closes aperature. Patient off loaded. Can t cheat Felt compresses over time and needs to be replaced every 2-3 weeks Felt donuts used for toes and heels Technique not covered by medicare 19

20 OFF LOADING OPTIONS Darco Post op Boot Rocker bottom for gradual transition of pressure Soft and adjustable upper to avoid pressure on wounds Cheaper than a full orthotic and shoe Can apply felt inside Darco or on foot Not durable in the long term but good transition option INFECTED DIABETIC FOOT ULCER 20

21 AIRCAST WALKER PATIENT OUTCOMES FROM ORIGINAL STUDY Study enrolled 83 patients between January 2 and October 31, Patient Demographics 90% Type 2 diabetics Duration of ulcer at baseline /- 2.7 weeks /- 0.41cm sq. and 0.65 =/ deep 114 ulcers at baseline 78 (68%) healed within the study 7.4 weeks to heal over 3.8 clinic visits all ulcers combined (Literature reports time to healing between 11 to 14 weeks in specialist diabetic foot clinics. Neuroischaemic longer than neuropathic) 22 recurrent ulcers (19%) (literature reports relapse rate of 30%) 82% healed (recurrence size smaller) 32 new ulcers. 55% healed 46 patients (55%) ulcer free at end of study 21

22 WHERE WE ARE TODAY (2015 STATS) 257 inactive patients since active patients 25 pending consults Longer wait time to get in More infections Relapses more common International wound Journal, Dubsky et al Risk factors for recurrence diabetic foot ulcers. 57.5% relapse rate after 3 years. Independent risk factors included plantar location, bone infection, poor diabetes control, elevated CRP Some remarkable healing times for chronic ulcers with offloading (less than 6 weeks for ulcers with duration 1-2 years) Recent bad outcomes with infected Charcot feet..more CROW walkers? Charcot Restraint Orthotic Walker WHERE CAN YOU FIND US? London Diabetic Foot Clinic: 310 Wellington St. London Ontario Consults through Dr. Thompson s office at SJHC Fax Clinic Phone Number

Diabetic Foot Ulcers and Pressure Ulcers. Laurie Duckett D.O. Plastic and Reconstructive Surgeon Oklahoma State University Center for Health Sciences

Diabetic Foot Ulcers and Pressure Ulcers. Laurie Duckett D.O. Plastic and Reconstructive Surgeon Oklahoma State University Center for Health Sciences Diabetic Foot Ulcers and Pressure Ulcers Laurie Duckett D.O. Plastic and Reconstructive Surgeon Oklahoma State University Center for Health Sciences Lecture Objectives Identify risk factors Initiate appropriate

More information

Critically evaluate the organization of diabetic foot ulcer services and interdisciplinary team working

Critically evaluate the organization of diabetic foot ulcer services and interdisciplinary team working Rationale of Module Accurate nursing assessment is the key to effective diabetic foot ulcer prevention, treatment and management. A comprehensive assessment identifies ulcer aetiology and the factors which

More information

Foot and Ankle Pain? Get Solutions!! Presented by Mark Birmingham, DPM, AACFAS

Foot and Ankle Pain? Get Solutions!! Presented by Mark Birmingham, DPM, AACFAS Foot and Ankle Pain? Get Solutions!! Presented by Mark Birmingham, DPM, AACFAS Overview My Background Podiatry: What it was, What it is today Common Ailments of the Foot and Ankle Conservative and Surgical

More information

APPENDIX 1: INTERDISCIPLINARY APPROACH TO PREVENTION AND MANAGEMENT OF DIABETIC FOOT COMPLICATIONS

APPENDIX 1: INTERDISCIPLINARY APPROACH TO PREVENTION AND MANAGEMENT OF DIABETIC FOOT COMPLICATIONS APPENDIX 1: INTERDISCIPLINARY APPROACH TO PREVENTION AND MANAGEMENT OF DIABETIC FOOT COMPLICATIONS Template: Regional Foot Programs should develop a list of available health professionals in the following

More information

Antimicrobial Guidelines for the Empirical Management of Diabetic Foot Infections

Antimicrobial Guidelines for the Empirical Management of Diabetic Foot Infections Antimicrobial Guidelines for the Empirical Management of Diabetic Foot Infections APPROVED BY: TRUST REFERENCE: DMS: 43622 Date (approved): June 2007 MOST RECENT REVIEW: November 2011 NEXT REVIEW: May

More information

Wound Classification Name That Wound Sheridan, WY June 8 th 2013

Wound Classification Name That Wound Sheridan, WY June 8 th 2013 Initial Wound Care Consult Sheridan, WY June 8 th, 2013 History Physical Examination Detailed examination of the wound Photographs Cultures Procedures TCOM ABI Debridement Management Decisions A Detailed

More information

Wound Care: The Basics

Wound Care: The Basics Wound Care: The Basics Suzann Williams-Rosenthal, RN, MSN, WOC, GNP Norma Branham, RN, MSN, WOC, GNP University of Virginia May, 2010 What Type of Wound is it? How long has it been there? Acute-generally

More information

A NEW CLASSIFICATION OF DIABETIC FOOT COMPLICATIONS: A SIMPLE AND EFFECTIVE TEACHING TOOL

A NEW CLASSIFICATION OF DIABETIC FOOT COMPLICATIONS: A SIMPLE AND EFFECTIVE TEACHING TOOL The Journal of Diabetic Foot Complications A NEW CLASSIFICATION OF DIABETIC FOOT COMPLICATIONS: A SIMPLE AND EFFECTIVE TEACHING TOOL Authors: Dr Amit Kumar C Jain* *MBBS, D.DIAB, F.DIAB, DNB[Gen Surgery],

More information

Toenail Removal , The Patient Education Institute, Inc. po Last reviewed: 10/27/2014 1

Toenail Removal , The Patient Education Institute, Inc.  po Last reviewed: 10/27/2014 1 Toenail Removal Introduction Toenail removal is often done for severe fungal nail infections or for ingrown toenails. Part or all of the toenail may be removed. The procedure can be done in your health

More information

Wound and Skin Assessment. Mary Carvalho RN, BSN, MBA Clinical Coordinator Johnson Creek Wound and Edema Center

Wound and Skin Assessment. Mary Carvalho RN, BSN, MBA Clinical Coordinator Johnson Creek Wound and Edema Center Wound and Skin Assessment Mary Carvalho RN, BSN, MBA Clinical Coordinator Johnson Creek Wound and Edema Center Skin The largest Organ Weighs between 6 and 8 pounds Covers over 20 square feet Thickness

More information

Forefoot deformity correction

Forefoot deformity correction Contact us Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: 020 7188 8748 9am to 5pm, Monday to

More information

How does Diabetes Effect the Feet

How does Diabetes Effect the Feet How does Diabetes Effect the Feet What Skin Changes May Occur? Diabetes can cause changes in the skin of your foot. At times your foot may become very dry. The skin may peel and crack. The problem is that

More information

Post-surgical V.A.C. VeraFlo Therapy with Prontosan Instillation on Inpatient Infected Wounds * COLLECTION OF CASE STUDIES

Post-surgical V.A.C. VeraFlo Therapy with Prontosan Instillation on Inpatient Infected Wounds * COLLECTION OF CASE STUDIES COLLECTION OF CASE STUDIES Post-surgical V.A.C. VeraFlo Therapy with Prontosan Instillation on Inpatient Infected Wounds * *All patients were treated with systemic antibiotics Post-surgical V.A.C. VeraFlo

More information

CLINICAL PROTOCOL FOR THE MANAGEMENT OF FOOT CARE FOR DIABETIC PATIENTS

CLINICAL PROTOCOL FOR THE MANAGEMENT OF FOOT CARE FOR DIABETIC PATIENTS CLINICAL PROTOCOL FOR THE MANAGEMENT OF FOOT CARE FOR DIABETIC PATIENTS RATIONALE Clinical evidence suggests that there is considerable potential to improve the quality of foot care for people with diabetes.

More information

TAKING CARE OF WOUNDS KEY FIGURE:

TAKING CARE OF WOUNDS KEY FIGURE: Chapter 9 TAKING CARE OF WOUNDS KEY FIGURE: Gauze Wound care represents a major area of concern for the rural health provider. This chapter discusses the treatment of open wounds, with emphasis on dressing

More information

Chapter 7. Expose the Injured Area

Chapter 7. Expose the Injured Area Chapter 7 GUNSHOT WOUNDS KEY FIGURES: Entrance/exit wounds This chapter describes how to treat the external, surface wounds caused by a bullet. The evaluation for underlying injury related to gunshot wounds

More information

Wound Care on the Field. Objectives

Wound Care on the Field. Objectives Wound Care on the Field Brittany Witte, PT, DPT Cook Children s Medical Center Objectives Name 3 different types of wounds commonly seen in sports and how to emergently provide care for them. Name all

More information

Calcaneus (Heel Bone) Fractures

Calcaneus (Heel Bone) Fractures Copyright 2010 American Academy of Orthopaedic Surgeons Calcaneus (Heel Bone) Fractures Fractures of the heel bone, or calcaneus, can be disabling injuries. They most often occur during high-energy collisions

More information

Treat Your Feet: Foot care for people with diabetes

Treat Your Feet: Foot care for people with diabetes Treat Your Feet: Foot care for people with diabetes UHN People with diabetes often have trouble with their feet. Read this booklet to learn 7 steps to keep your feet healthy. Please visit the UHN Patient

More information

.org. Posterior Tibial Tendon Dysfunction. Anatomy. Cause. Symptoms

.org. Posterior Tibial Tendon Dysfunction. Anatomy. Cause. Symptoms Posterior Tibial Tendon Dysfunction Page ( 1 ) Posterior tibial tendon dysfunction is one of the most common problems of the foot and ankle. It occurs when the posterior tibial tendon becomes inflamed

More information

Bunionectomy (and 1st Metatarsal Osteotomy)

Bunionectomy (and 1st Metatarsal Osteotomy) Bunionectomy (and 1st Metatarsal Osteotomy) A bunion is a bony bump, resulting from a misaligned joint, on the side of the big toe. A bunion is typically painful and may be unsightly. Bunions are primarily

More information

Orthotic Management for the Foot

Orthotic Management for the Foot Orthotic Definition Orthotic Management for the Foot Michael Barnett Jr., MD Assistant Professor of Orthopaedic Surgery Boonshoft School of Medicine Wright State University Devices placed inside shoe Accommodative

More information

SURGICAL COMPLICATIONS OF DIABETES MELLITUS. Dr.M.Baskaran Selvapathy

SURGICAL COMPLICATIONS OF DIABETES MELLITUS. Dr.M.Baskaran Selvapathy SURGICAL COMPLICATIONS OF DIABETES MELLITUS Dr.M.Baskaran Selvapathy 1 DEFINITION Diabetes Mellitus is regarded as a syndrome characterized by chronic hyperglycemia due to relative deficiency of insulin

More information

Chapter 11. Everting skin edges

Chapter 11. Everting skin edges Chapter 11 PRIMARY WOUND CLOSURE KEY FIGURE: Everting skin edges In primary wound closure, the skin edges of the wound are sutured together to close the defect. Whenever possible and practical, primary

More information

CHAPTER 5 THE USE OF LEPTOSPERMUM HONEY IN CHRONIC WOUND MANAGEMENT

CHAPTER 5 THE USE OF LEPTOSPERMUM HONEY IN CHRONIC WOUND MANAGEMENT The use of Leptospermum honey in chronic wound management CHAPTER 5 THE USE OF LEPTOSPERMUM HONEY IN CHRONIC WOUND MANAGEMENT Val Robson In recent years the use of honey to manage wounds has gained considerable

More information

Case Report (online only) Charcot neuroarthropathy triggered and complicated by osteomyelitis. How limb salvage can be achieved

Case Report (online only) Charcot neuroarthropathy triggered and complicated by osteomyelitis. How limb salvage can be achieved 1 1 1 1 1 1 0 1 0 0 1 0 1 Case Report (online only) Charcot neuroarthropathy triggered and complicated by osteomyelitis. How limb salvage can be achieved J. Aragon-Sanchez 1,J.L.Lazaro-Martınez, Y. Quintana-Marrero

More information

CELLULITIS. Cellulitis is a common presentation to the Emergency Department.

CELLULITIS. Cellulitis is a common presentation to the Emergency Department. CELLULITIS Introduction Cellulitis is a common presentation to the Emergency Department. The term cellulitis refers to an uncomplicated non-necrotizing acute infection of the skin that involves the mid

More information

Endoscopic Plantar Fasciotomy

Endoscopic Plantar Fasciotomy Endoscopic Plantar Fasciotomy Introduction Plantar fasciitis is a common condition that causes pain centralized around the heel. It may be severe enough to affect regular activities. Health care providers

More information

.org. Plantar Fasciitis and Bone Spurs. Anatomy. Cause

.org. Plantar Fasciitis and Bone Spurs. Anatomy. Cause Plantar Fasciitis and Bone Spurs Page ( 1 ) Plantar fasciitis (fashee-eye-tiss) is the most common cause of pain on the bottom of the heel. Approximately 2 million patients are treated for this condition

More information

Heel pain causes and treatments

Heel pain causes and treatments Heel pain causes and treatments Dr. Kenneth Oglesby, DPM, ACFAS Board certified in foot and ankle surgery 7/31/2014 1 Kenneth Oglesby, DPM, ACFAS Graduate of the New York College of Podiatric Medicine

More information

Introduction to Wound Management

Introduction to Wound Management EWMA Educational Development Programme Curriculum Development Project Education Module: Introduction to Wound Management Latest revision: October 2012 ABOUT THE EWMA EDUCATIONAL DEVELOPMENT PROGRAMME The

More information

Illinois Department of Public Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION. Statement of LICENSURE Violations

Illinois Department of Public Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION. Statement of LICENSURE Violations (X1) PROVER/SUPPLIER/CLIA ENTIFICATION NUMBER: (X3) SURVEY D NAME OF PROVER OR SUPPLIER (X4) SUMMARY REGULATORY OR LSC ENTIFYING INFORMATION) PROVER'S PLAN OF CORRECTION Final Observations Statement of

More information

A Patient s Guide to Arthritis of the Big Toe (Hallux Rigidus) With Discussion on Cheilectomy and Fusion

A Patient s Guide to Arthritis of the Big Toe (Hallux Rigidus) With Discussion on Cheilectomy and Fusion A Patient s Guide to Arthritis of the Big Toe (Hallux Rigidus) With Discussion on Cheilectomy and Fusion The foot and ankle unit at the Royal National Orthopaedic Hospital (RNOH) is a multi-disciplinary

More information

الكلب عضة = bite Dog Saturday, 09 October 2010 18:56 - Last Updated Wednesday, 09 February 2011 06:07

الكلب عضة = bite Dog Saturday, 09 October 2010 18:56 - Last Updated Wednesday, 09 February 2011 06:07 Dog bite Almost 75 million dogs live in the United States, and since many victims of dog bites don't seek medical care or report the attack, it may be that the U.S. Center for Disease Control and Prevention

More information

Plantar Fasciitis. Plantar Fascia

Plantar Fasciitis. Plantar Fascia Plantar Fasciitis Introduction Plantar fasciitis is an inflammation of the thick band of tissue that connects your heel bone to your toes. This thick band of tissue is called the plantar fascia. Plantar

More information

More hospital days are spent treating diabetic foot infections than any other complication of this disease.

More hospital days are spent treating diabetic foot infections than any other complication of this disease. DIABETIC FOOT CARE The disease known as DIABETES MELLITUS affects many parts of the body, especially the feet. It is very important that a diabetic give the feet very special care. A small problem in a

More information

Cellulitis. Patient information Leaflet. Leaflet no: GMed 005 Version 1.2

Cellulitis. Patient information Leaflet. Leaflet no: GMed 005 Version 1.2 Cellulitis Patient information Leaflet Leaflet no: GMed 005 Version 1.2 October 2013 What is Cellulitis? Cellulitis is a bacterial infection of the deep layer of skin (dermis) and the layer of fat and

More information

Predislocation syndrome

Predislocation syndrome Predislocation syndrome Sky Ridge Medical Center, Aspen Building Pre-dislocation syndrome, capsulitis, and metatarsalgia are all similar problems usually at the ball of the foot near the second and third

More information

Rheumatoid Arthritis of the Foot and Ankle

Rheumatoid Arthritis of the Foot and Ankle Copyright 2011 American Academy of Orthopaedic Surgeons Rheumatoid Arthritis of the Foot and Ankle Rheumatoid arthritis is a chronic disease that attacks multiple joints throughout the body. It most often

More information

Use of Packing for Surgical Wounds. Maggie Benson Clinical Problem Solving II

Use of Packing for Surgical Wounds. Maggie Benson Clinical Problem Solving II Use of Packing for Surgical Wounds Maggie Benson Clinical Problem Solving II Purpose Present patient management s/p Incision and Drainage in an outpatient setting Examine evidence for the use of wound

More information

7/30/2012. Increased incidence of chronic diseases due

7/30/2012. Increased incidence of chronic diseases due Dianne Rudolph, DNP, GNP bc, CWOCN Discuss management of wound care in older adults with focus on lower extremity ulcers Identify key aspects of prevention Explain basic principles of wound management

More information

Recurrent Varicose Veins

Recurrent Varicose Veins Information for patients Recurrent Varicose Veins Sheffield Vascular Institute Northern General Hospital You have been diagnosed as having Varicose Veins that have recurred (come back). This leaflet explains

More information

Diabetes : Foot Education

Diabetes : Foot Education Diabetes : Foot Education Dr. Naushira Pandya, M.D., CMD, Sweta Tewary, PhD, MSW Department of Geriatrics Nova Southeastern University Florida Coastal Geriatric Resources, Education, and Training Center

More information

PATIENT TEACHING GUIDE: Wound Care Handbook

PATIENT TEACHING GUIDE: Wound Care Handbook PATIENT TEACHING GUIDE: Wound Care Handbook PATIENT TEACHING GUIDE: WOUND CARE Design by Mariscal Design, Illustrations by Lysa Hawke. The Wound Care Self Care Guide was written and prepared by: Barbara

More information

Plantar Fascia Release

Plantar Fascia Release Plantar Fascia Release Introduction Plantar fasciitis is a common condition that causes pain around the heel. It may be severe enough to affect regular activities. If other treatments are unsuccessful,

More information

Podiatry Specialty ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Podiatry and Top 20 codes

Podiatry Specialty ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Podiatry and Top 20 codes Podiatry Specialty ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Podiatry and Top 20 codes Chapter 1 Certain Infectious and Parasitic Diseases Terminology changes: The term sepsis (ICD-10-CM)

More information

Y O U R S U R G E O N S. choice of. implants F O R Y O U R S U R G E R Y

Y O U R S U R G E O N S. choice of. implants F O R Y O U R S U R G E R Y Y O U R S U R G E O N S choice of implants F O R Y O U R S U R G E R Y Y O U R S U R G E O N S choice of implants F O R Y O U R S U R G E R Y Your Surgeon Has Chosen the C 2 a-taper Acetabular System The

More information

AIRCAST BOOTS SUPPLIED FROM THE OUTPATIENT DEPARTMENT

AIRCAST BOOTS SUPPLIED FROM THE OUTPATIENT DEPARTMENT AIRCAST BOOTS SUPPLIED FROM THE OUTPATIENT DEPARTMENT Information Leaflet Your Health. Our Priority. Page 2 of 7 General information The standard walking boot provides air support for stable fractures,

More information

Chapter 5. Objectives. Normal Ankle Range of Motion. Lateral Ankle Sprains. Lateral Ankle Sprains. Assessment of Lateral Ankle Sprains

Chapter 5. Objectives. Normal Ankle Range of Motion. Lateral Ankle Sprains. Lateral Ankle Sprains. Assessment of Lateral Ankle Sprains Objectives Chapter 5 Assessment of Ankle & Lower Leg Injuries Review the following components of injury assessment related to the ankle and lower leg Stress tests Special tests Normal Ankle Range of Motion

More information

Breast Implants: Local Complications and Adverse Outcomes

Breast Implants: Local Complications and Adverse Outcomes Breast Implants: Local Complications and Adverse Outcomes This booklet highlights the most common problems associated with silicone gel-filled and saline-filled breast implants: those that occur in the

More information

RX: Custom Thermoplastic AFO Compliance Documentation

RX: Custom Thermoplastic AFO Compliance Documentation RX: Custom Thermoplastic AFO Compliance Documentation Doctor Name: Phone: Patient Name: HICN: DOB: Indicate Quality ARIZONA THERMOPLASTIC ARTICULATED AFO, DORSI-ASSIST CROW L4631 A bivalved custom molded

More information

Varicose Vein Surgery

Varicose Vein Surgery Information for patients Varicose Vein Surgery Northern General Hospital You have been diagnosed as having varicose veins and your specialist has recommended varicose vein surgery. This leaflet explains

More information

Algidex Ag. wet - moist - dry wound

Algidex Ag.  wet - moist - dry wound Algidex Ag wet - moist - dry wound Algidex Ag is a unique combination of silver, alginate and maltodextrin. It provides immediate and sustained antimicrobial action against a broad spectrum of wound pathogens

More information

A Guide to Heel Pain

A Guide to Heel Pain The Society of Chiropodists and Podiatrists A Guide to Heel Pain The Society of Chiropodists and Podiatrists Heel pain may be caused by a number of different problems; for effective treatment you need

More information

Broström Lateral Ligament Reconstruction of Ankle

Broström Lateral Ligament Reconstruction of Ankle Broström Lateral Ligament Reconstruction of Ankle This leaflet aims to answer your questions about having a broström lateral ligament reconstruction of ankle under the care of Mr Sam Singh. It explains

More information

Plantar Fasciitis and Bone Spurs

Plantar Fasciitis and Bone Spurs Copyright 2010 American Academy of Orthopaedic Surgeons Plantar Fasciitis and Bone Spurs Plantar fasciitis (fashee-eye-tiss) is the most common cause of pain on the bottom of the heel. Approximately 2

More information

ARTHROSCOPIC HIP SURGERY

ARTHROSCOPIC HIP SURGERY ARTHROSCOPIC HIP SURGERY Hip Arthroscopy is a relatively simple procedure whereby common disorders of the hip can be diagnosed and treated using keyhole surgery. Some conditions, which previously were

More information

Wound Care/HBO Symposium

Wound Care/HBO Symposium PRESENTS: Wound Care/HBO Symposium Friday, November 2, 2012 8:00 a.m. - 4:45 p.m. LOCATION Hilton Garden Inn-Levis Commons 6165 Levis Commons Blvd. Perrysburg, OH 43551 INTRODUCTION This symposium was

More information

Previous history of ulcers on feet which were alleviated by introduction of Propet stretch shoes

Previous history of ulcers on feet which were alleviated by introduction of Propet stretch shoes EDP- A case study for Vasyli medical trialling diabetic insole and Dr Comfort footwear BY SALLY LAXTON BAppSci(Pod) PODIATRIST- Knox Community Health Service EDP is a 68 year old female solid build Medical

More information

Adult Forearm Fractures

Adult Forearm Fractures Adult Forearm Fractures Your forearm is made up of two bones, the radius and ulna. In most cases of adult forearm fractures, both bones are broken. Fractures of the forearm can occur near the wrist at

More information

Guidance on sampling techniques for laboratory-confirmation of Mycobacterium ulcerans infection (Buruli ulcer disease)

Guidance on sampling techniques for laboratory-confirmation of Mycobacterium ulcerans infection (Buruli ulcer disease) Guidance on sampling techniques for -confirmation of Mycobacterium ulcerans Background Advances in the clinical management of Mycobacterium ulcerans have shifted options for treatment from surgical management

More information

Rheumatoid Arthritis: Symptoms, Causes, and Treatments of Rheumatoid Foot and Ankle

Rheumatoid Arthritis: Symptoms, Causes, and Treatments of Rheumatoid Foot and Ankle Rheumatoid arthritis is the most common form of inflammatory arthritis, affecting about two to three million Americans. Rheumatoid arthritis is a symmetric disease, meaning that it will usually involve

More information

2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections a

2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections a IDSA GUIDELINES 2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections a Benjamin A. Lipsky, 1 Anthony R. Berendt, 2 Paul B.

More information

STEVEN D. FEINBERG, MD, MPH

STEVEN D. FEINBERG, MD, MPH STEVEN D. FEINBERG, MD, MPH Board Certified, Physical Medicine & Rehabilitation Board Certified, Pain Medicine Qualified Medical Evaluator Adjunct Clinical Professor, Stanford School of Medicine Feinberg

More information

Provided by the American Venous Forum: veinforum.org

Provided by the American Venous Forum: veinforum.org CHAPTER 1 NORMAL VENOUS CIRCULATION Original author: Frank Padberg Abstracted by Teresa L.Carman Introduction The circulatory system is responsible for circulating (moving) blood throughout the body. The

More information

Plastic, Vascular & Podiatry the Georgetown Model

Plastic, Vascular & Podiatry the Georgetown Model Plastic, Vascular & Podiatry the Georgetown Model Christopher Attinger,, MD SVS June 15,2011 Chicago Disclosure: None for this talk Wound Center Financial Viability: outline Clinical success Team approach

More information

Hemodialysis Access: What You Need to Know

Hemodialysis Access: What You Need to Know Hemodialysis Access: What You Need to Know Hemodialysis Access: What You Need To Know Whether you already get hemodialysis treatment, or you will need to start dialysis soon, this booklet will help you

More information

Wounds, OASIS and Coding

Wounds, OASIS and Coding This handout includes slides from parts one and two of the Wounds, OASIS and Coding seminar Wounds, OASIS and Coding Lisa Selman-Holman JD, BSN, RN, CHCE, HCS-D, COS-C Selman-Holman & Associates, LLC This

More information

UHealth Sports Medicine

UHealth Sports Medicine UHealth Sports Medicine Rehabilitation Guidelines for Meniscal Repair The rehabilitation guidelines are presented in a criterion based progression. Specific time frames, restrictions and precautions are

More information

Sports Injuries of the Foot and Ankle. Dr. Travis Kieckbusch August 7, 2014

Sports Injuries of the Foot and Ankle. Dr. Travis Kieckbusch August 7, 2014 Sports Injuries of the Foot and Ankle Dr. Travis Kieckbusch August 7, 2014 Foot and Ankle Injuries in Athletes Lateral ankle sprains Syndesmosis sprains high ankle sprain Achilles tendon injuries Lisfranc

More information

BEST PRACTICE GUIDELINES: WOUND MANAGEMENT IN DIABETIC FOOT ULCERS

BEST PRACTICE GUIDELINES: WOUND MANAGEMENT IN DIABETIC FOOT ULCERS INTERNATIONAL GUIDELINES: WOUND IN DIABETIC FOOT ULCERS 3 GUIDELINES FOR SKIN AND WOUND CARE IN EPIDERMOLYSIS BULLOSA FOREWORD Supported by an educational grant from B Braun The views presented in this

More information

Wound Healing. Healing is a matter of time, but it is sometimes also a matter of opportunity. Hippocrates

Wound Healing. Healing is a matter of time, but it is sometimes also a matter of opportunity. Hippocrates C HAPTER 9 Wound Healing Healing is a matter of time, but it is sometimes also a matter of opportunity. Hippocrates As the above quote suggests, conduct regular and systematic wound assessments, and seize

More information

PLANTAR FASCITIS (Heel Spur Syndrome)

PLANTAR FASCITIS (Heel Spur Syndrome) PLANTAR FASCITIS (Heel Spur Syndrome) R. Amadeus Mason MD Description Plantar fascitis is characterized by stiffness and inflammation of the main fascia (fibrous connective [ligament-like] tissue) on the

More information

Understanding Vascular Disease. The Ohio State University Heart and Vascular Center

Understanding Vascular Disease. The Ohio State University Heart and Vascular Center Understanding Vascular Disease The Ohio State University Heart and Vascular Center What is Vascular Disease? The vascular system is the body s network of blood vessels. It includes the arteries, veins

More information

Podiatric Medicine. What is a Podiatrist?

Podiatric Medicine. What is a Podiatrist? Page 3 Podiatric Medicine Podiatric Medicine is the profession that strives to improve the overall health and wellbeing of patients by focusing on preventing, diagnosing, and treating conditions associated

More information

DIABETES FOOT EDUCATION; AN EVIDENCE-BASED APPROACH IN LONG-TERM CARE

DIABETES FOOT EDUCATION; AN EVIDENCE-BASED APPROACH IN LONG-TERM CARE DIABETES FOOT EDUCATION; AN EVIDENCE-BASED APPROACH IN LONG-TERM CARE Naushira Pandya, MD, CMD Professor and Chair Director, Geriatrics Education Center Nova Southeastern University College of Osteopathic

More information

Fusion of the great (or big) toe

Fusion of the great (or big) toe Fusion of the great (or big) toe Exceptional healthcare, personally delivered Following your consultation with a member of the Foot and Ankle team you have been diagnosed as needing a fusion of the great

More information

Streptococcal Infections

Streptococcal Infections Streptococcal Infections Introduction Streptococcal, or strep, infections cause a variety of health problems. These infections can cause a mild skin infection or sore throat. But they can also cause severe,

More information

Detecting and treating Elevated Protease Activity (EPA) in chronic diabetic wounds

Detecting and treating Elevated Protease Activity (EPA) in chronic diabetic wounds Detecting and treating Elevated Protease Activity (EPA) in chronic diabetic wounds Anichini R., Tedeschi A., Bernini A., De Bellis A. Diabetes Unit and Diabetes Foot Unit, General Hospital USL 3 Pistoia,

More information

Plantar Fasciitis heel pain arising from the chronic tearing of the plantar fascia from the heel bone due to a drop in the arch or trauma.

Plantar Fasciitis heel pain arising from the chronic tearing of the plantar fascia from the heel bone due to a drop in the arch or trauma. Introduction heel pain arising from the chronic tearing of the plantar fascia from the heel bone due to a drop in the arch or trauma. What is Planter Fasciitis caused by? The function of the heel in walking

More information

Patient Guide. Sacroiliac Joint Pain

Patient Guide. Sacroiliac Joint Pain Patient Guide Sacroiliac Joint Pain Anatomy Where is the Sacroiliac Joint? The sacroiliac joint (SIJ) is located at the bottom end of your spine, where the "tailbone" (sacrum) joins the pelvis (ilium).

More information

Sprained Ankle - OrthoInfo - AAOS. Copyright 2005 American Academy of Orthopaedic Surgeons. Sprained Ankle

Sprained Ankle - OrthoInfo - AAOS. Copyright 2005 American Academy of Orthopaedic Surgeons. Sprained Ankle Copyright 2005 American Academy of Orthopaedic Surgeons Sprained Ankle A sprained ankle is a very common injury. Approximately 25,000 people experience it each day. A sprained ankle can happen to athletes

More information

Medical Affairs Policy

Medical Affairs Policy Medical Affairs Policy Service: Hyperbaric Oxygen Therapy PUM 250-0017 Implemented 07/15/15 Arise/WPS Policy 06/13/14, 06/12/15 Committee Approval Reviewed 06/13/14, 06/12/15 Revised 06/12/15 Developed

More information

Anatomy of the Skin and a Clinical Approach to Patients with Skin Disease

Anatomy of the Skin and a Clinical Approach to Patients with Skin Disease C H A P T E R Anatomy of the Skin and a Clinical Approach to Patients with Skin Disease 1 1 This manual will begin with a brief revision of the main structures and functions of the skin. Much of this manual

More information

Sky Ridge Medical Center, Aspen Building Ridgegate Pkwy., Suite 309 Lone Tree, Colorado Office: Fax:

Sky Ridge Medical Center, Aspen Building Ridgegate Pkwy., Suite 309 Lone Tree, Colorado Office: Fax: Plantar Fasciitis Plantar fasciitis is inflammation of the thick tissue on the bottom of the foot. This tissue is called the plantar fascia. It connects the heel bone to the toes and creates the arch of

More information

Concepts in Orthopaedic Care: Hand Infections. Scott M Wein MD Raleigh Orthopaedic Clinic 9/24/11. Hand Infections

Concepts in Orthopaedic Care: Hand Infections. Scott M Wein MD Raleigh Orthopaedic Clinic 9/24/11. Hand Infections Concepts in Orthopaedic Care: Hand Infections Scott M Wein MD Raleigh Orthopaedic Clinic 9/24/11 Hand Infections Infections may be a source of considerable morbidity Expeditious treatment is necessary

More information

Periodontal (Gum) Disease. Causes, Symptoms, and Treatments. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health

Periodontal (Gum) Disease. Causes, Symptoms, and Treatments. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Periodontal (Gum) Disease Causes, Symptoms, and Treatments U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Periodontal (Gum) Disease If you have been told you have periodontal

More information

Varicose Veins Operation. Patient information Leaflet

Varicose Veins Operation. Patient information Leaflet Varicose Veins Operation Patient information Leaflet 22 nd August 2014 WHAT IS VARICOSE VEIN SURGERY (HIGH LIGATION AND MULTIPLE AVULSIONS) The operation varies from case to case, depending on where the

More information

EAST CAROLINA UNIVERSITY INFECTION CONTROL POLICY. Methicillin-resistant Staph aureus: Management in the Outpatient Setting

EAST CAROLINA UNIVERSITY INFECTION CONTROL POLICY. Methicillin-resistant Staph aureus: Management in the Outpatient Setting EAST CAROLINA UNIVERSITY INFECTION CONTROL POLICY Methicillin-resistant Staph aureus: Management in the Outpatient Setting Date Originated: Date Reviewed: Date Approved: Page 1 of Approved by: Department

More information

How can DIABETES affect my FEET? Emma Howard Community Diabetes Lead Podiatrist, Oxford Health NHS Foundation Trust

How can DIABETES affect my FEET? Emma Howard Community Diabetes Lead Podiatrist, Oxford Health NHS Foundation Trust How can DIABETES affect my FEET? By: Emma Howard Community Diabetes Lead Podiatrist, Oxford Health NHS Foundation Trust HOW CAN DIABETES AFFECT MY FEET? What is neuropathy? This leaflet explains how diabetes

More information

Once the immune system is triggered, cells migrate from the blood into the joints and produce substances that cause inflammation.

Once the immune system is triggered, cells migrate from the blood into the joints and produce substances that cause inflammation. HealthExchange Points For Your Joints An Arthritis Talk Howard Epstein, MD Orthopaedic & Rheumatologic Institute Rheumatic & Immunologic Disease Cleveland Clinic Beachwood Family Health & Surgery Center

More information

Neglected Wound/Poor Wound Care

Neglected Wound/Poor Wound Care Chapter 18 CHRONIC WOUNDS KEY FIGURES: Open wound Wound covered with skin graft Chronic wounds are open wounds that for some reason simply will not heal. They may be present for months or even years. Often,

More information

NPUAP PRESSURE ULCER ROOT CAUSE ANALYSIS (RCA) TEMPLATE National Pressure Ulcer Advisory Panel March 2014

NPUAP PRESSURE ULCER ROOT CAUSE ANALYSIS (RCA) TEMPLATE National Pressure Ulcer Advisory Panel March 2014 Purpose: The development of a facility acquired pressure ulcer brings with it both a financial impact to an institution and a performance or quality of care impact that may be reportable to state or government

More information

Initial Management of Acute Sports Injuries. By Martin Meyer Sports Physiotherapist Director APE

Initial Management of Acute Sports Injuries. By Martin Meyer Sports Physiotherapist Director APE Initial Management of Acute Sports Injuries By Martin Meyer Sports Physiotherapist Director APE Owned and operated by Perth physios with over 20 years experience Sports Medicine Wholesaler Strapping tapes

More information

NPUAP PRESSURE ULCER ROOT CAUSE ANALYSIS (RCA) TEMPLATE

NPUAP PRESSURE ULCER ROOT CAUSE ANALYSIS (RCA) TEMPLATE Purpose: The development of a facility acquired pressure ulcer brings with it both a financial impact to an institution and a performance or quality of care impact that may be reportable to state or government

More information

Topical Oxygen Wound Therapy (MEDICAID)

Topical Oxygen Wound Therapy (MEDICAID) Topical Oxygen Wound Therapy (MEDICAID) Last Review Date: September 11, 2015 Number: MG.MM.DM.15C6v2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or

More information

Pressure Ulcers: Facility Assessment Checklists

Pressure Ulcers: Facility Assessment Checklists Pressure Ulcers: Facility Assessment Checklists This is a series of self-assessment checklists for nursing home staff to use to assess processes related to managing pressure ulcers in the facility, in

More information

Patient Type 2 Diabetes

Patient Type 2 Diabetes Patient Type 2 Diabetes Aboriginal Health Workers Audiologists Chiropractors Diabetes Educators Dietitians Exercise Physiologists Mental Health Nurses Mental Health Social Workers Occupational Therapists

More information

APPLICATION OF DRY DRESSING

APPLICATION OF DRY DRESSING G-100 APPLICATION OF DRY DRESSING PURPOSE To aid in the management of a wound with minimal drainage. To protect the wound from injury, prevent introduction of bacteria, reduce discomfort, and assist with

More information

Modifiers Q7, Q8, and Q9

Modifiers Q7, Q8, and Q9 1-47 Modifiers Q7, Q8, and Q9 (Routine Foot Care) CPT Modifier Q7 One Class A finding Q8 Two Class B findings Q9 One Class B and two Class C findings General Information The Office of Inspector General

More information