Authors (including presenting author) :
Yeung HM(1), Leung SY(1), Tsui YT(1)
Affiliation :
(1)Podiatry Department, Queen Mary Hospital
Introduction :
According to International diabetes federation, the number of people with diabetes was 424.9 million and it is estimated that by 2045 the number would climb up to 628.6 million (1). Diabetes is one the major cause of lower limb amputation, stroke, kidney failure, heart attacks and blindness (2). Diabetic sensory neuropathy, autonomic neuropathy, motor neuropathy and arterial pathologies often appear in diabetic foot ulcer (DFU) (3). Therefore, DFU is a multi-factorial complicated condition to tackle in immunosuppressed subjects. In podiatry aspect, managing complications of DFU in order to prevent lower limb amputation and subsequent mortality is utter crucial. Hence, the following evaluation was done in hopes of improving DFU management in podiatric settings.
Objectives :
To evaluate the efficacy of DFU treatment in podiatric aspect.
Methodology :
New cases of 2017 diabetic ulcer subjects were collected from Queen Mary Hospital, Department of Podiatry. Total of 20 subjects’ data were sorted out and collected; 5 was discarded due to general condition deterioration or defaulted appointments; 15 was analyzed. Participant’s sex, age, medical condition, HbA1c, duration and cause of ulcer, podiatric intervention and outcomes were assessed. Subjects’ first conditions did not input at ‘diabetic ulcer’ would not be recruited.
Result & Outcome :
73% of DFU subjects were male (11). Average age of patients was 73 years old. 73% patients have multiple medical conditions (11), 20% had history of cardiovascular accident (3). Average HbA1c was 8%, ranging from 5.9% to 13.6%. 5 had sensory neuropathy (33%), assessed with abnormal 10g monofilament sensation and/or >25v vibration perception threshold on hallux, and 2 showed vascular insufficiency (13%), assessed with Dorsalis Pedis and Posterior Tibial pulses palpation. DFU included scald injury, pressure injury, sub-callus ulcer, ingrown toenail with necrotic ulcer, wet gangrene, pyogenic granuloma and ischemic ulcer. 13 out of 15 subjects healed (87%) while 2 referred to doctor due to wet gangrene (1) and 10 years non-healing pyogenic granuloma (1) for further management, i.e. surgical intervention and antibiotics cover. Onset of ulcer was ranging from 2 weeks to 10 years. Average number of appointment for ulcer healing was 3. Average healing time was 7.6 weeks. The shortest healing time was a scald injury within 9 days with daily follow-up. Mean follow up was 2 weeks; the shortest was 1 day. Podiatric treatments included foot assessment, wound management, ingrown toenail and callus reduction. Wound management includes pressure relief, wound bed preparation and applying suitable dressing.
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