1. Intervensi Ortotik Prostetik Pada Diabetik Foot IOPI Konferense Solo 2010 Markku Ripatti

2. Markku - IOPI 2010 Solo2 Diabetes Background summary Causes, Symptoms, Blood Sugar, Nutrition, Complications, Treatments, Prevention

3. Markku - IOPI 2010 Solo3 Diabetes and Foot problems  Diabetes and foot problems go hand and hand.  High levels of sugar damages nerves and arteries.

4. Markku - IOPI 2010 Solo4 Neuropathy and poor blood flow two main problems in diabetes Neuropathy - nerve damage Causes are high blood sugar levels and poor blood circulation.  Lost of sensation and may have difficulty of using muscles.  Muscles may become weakened and loose functionality  Too much pressure on one part of the foot  Cause blisters and sores develop.

5. Markku - IOPI 2010 Solo5 Neuropathy and poor blood flow two main problems in diabetes If not aware of foot injuries, then the injuries will go untreated and even small injuries can lead to a infection. Estimated 10% of diabetics develop potentially dangerous foot ulcers as a result of nerve damage that masked smaller injuries.

6. Markku - IOPI 2010 Solo6 Neuropathy and poor blood flow two main foot problems in diabetes: Poor blood flow - peripheral vascular disease Healing of cuts and infections is not good because oxygen- rich blood cannot reach the area of infection efficiently If infection goes for a prolonged amount of time without treatment or proper blood flow to the area, gangrene may develop Amputation is the most common treatment for gangrene.

7. Markku - IOPI 2010 Solo7 Care of Lower Extremities Numbness or Lack of Sensation in limbs (neuropathy), and/or Poor Circulation Neuropathy means that may not be able to feel hot or cold, or pain from an injury to protect the foot or stump. Not notice injury immediately – so a small problem like a small stone in a shoe or an ill-fitting prosthesis - if unnoticed - can lead to an ulcer.

8. Markku - IOPI 2010 Solo8 Common foot problems common among diabetes Athlete's Foot, Blisters, Bunions, Calluses, Corns, Dry Skin, Foot Ulcers, Fungal Infections, Ingrown Toenails,... Diabetes team approach: doctor, nurse, podiatrist, OP,...

9. Markku - IOPI 2010 Solo9 Footwear Proper footwear is important. Shoes have to provide enough cushioning and comfort; good pressure distribution. Shoes have to fit well; they have to be wide enough across the toes and do not restrict circulation. Shoes have to at the right heel height for the alignment of the prosthesis, and should be replaced when become worn. Use of seam-free socks will help improve circulation.

10. Markku - IOPI 2010 Solo10 Orthotic care Orthotist can design custom-fitting shoes to prevent pressure areas from developing, or Other devices, such as a patellar tendon bearing knee brace, to relieve pressures on the foot. Or make an comfortable insole. Create relieve on pressure areas Follow biomechanics

11. Markku - IOPI 2010 Solo11 Prosthetic care Socket is the most important! Socket has to fit well and not restrict circulation. Flexible total contact sockets are good for amputees with diabetes, since they reduce discomfort and swelling in the stump. Silicone and urethane gel sockets and liners can make the prosthesis comfortable to wear. The layer of cushioning provide help to reduce skin irritations and help amputee to tolerate forces within a socket.

12. Markku - IOPI 2010 Solo12 Prosthetic use Lightweight prosthesis means that less energy expenditure during walking. Choosing the prosthetic foot to be appropriate. Elastic keel feet are comfortable, soft to walk. Having a ”good gait” facilitates an active lifestyle. Check if there are any bad habits or gait deviations which can be corrected. Walking should go as well as possible, and not put any additional strain on residual limb or sound limb.

13. Markku - IOPI 2010 Solo13 Self-check /-care Make sure that also stump skin is clean and dry, and no pressure points caused by socket and stump socks or liners. Check feet daily to prevent bacteria from growing. Handy to use diabetic foot care kits, which contain mirror to see the underside of foot and foot-brush to apply medication to hard-to-reach areas. Trim toenails straight across see a specialist (like podiatrist) for treating calluses and bunions.  Always wear your prosthesis or mobility aid Balance food, physical activity and medication

14. Markku - IOPI 2010 Solo14 Summary Diabetes and foot problems Neuropathy Peripheral vascular disease Lack of sensation Diabetes team Foot wear Orthotic care Prosthetic care Self-check / -care Two thirds of amputation in people with diabetes can be prevented by proper foot care!

15. Markku - IOPI 2010 Solo15 Thank you Terima kasih