Toe Deformities in Diabetic Patients: A Case Study. скачать в хорошем качестве

Toe Deformities in Diabetic Patients: A Case Study.

THESE ARE THE TOE DEFORMITIES WE SPOKE ABOUT BECAUSE OF THAT MOTOR NEUROPATHY, HAMMER TOES ARE ACTUALLY REPORTED IN A GREAT NUMBER OF OUR DIABETIC PATIENTS IT'S BEEN ESTIMATED 32 TO 46 PERCENT OF PATIENTS WITH DIABETES HAVE HAMMER TOES, BECAUSE THAT MUSCLE WASTING. IT'S A COMMON CAUSE OF ULCERS ON THE FOREFOOT, AND THE PRESENCE OF A HAMMER TOE IN ONE PARTICULAR STUDY WAS NOTED TO BE THE MOST IMPORTANT PREDICTOR OF PLANTAR PRESSURES. SO, NOT ONLY HAVING A TOE ULCER, OR HAMMER TOE, RATHER, YOU CAN GET BOTTOM OF THE FOOT PROBLEMS AS WELL, SO WE GET THAT RETROGRADE PRESSURE OF THE TOE, SITTING ON THE METATARSAL HEAD, IT SITS DOWN MORE PLANTARLY, YOU HAVE THAT PLANTAR FAT PAD ATROPHY, SO YOU DON'T HAVE THAT CUSHION, SO YOU'RE KIND OF LIKE WALKING ON A MARBLE, PATIENT DEVELOPS CALLUS, SKIN BREAKDOWN, ULCER DEVELOPMENTS, SO THE TOE DEFORMITIES IN DIABETICS CAN BE A PROBLEM, SO THAT'S SOMETHING DEFINITELY TO ASSESS AND ADDRESS WHEN YOU'RE LOOKING AT YOUR PATIENTS WITH DIABETES. HERE'S A CASE OF A PATIENT THAT HAD A TOE DEFORMITY HE HAD A HAMMER TOE AND YOU CAN SEE HIS SECOND TOE IS A LOT LONGER YOU KNOW SO OBVIOUSLY HAS SOME NAIL DYSTROPHY AS WELL THIS 57 YEAR OLD, NON-INSULIN DEPENDENT DIABETIC. HE WAS ADMITTED TO THE HOSPITAL WITH A RED HOT SWOLLEN FOOT, AFTER WEARING A NEW PAIR OF SHOES. OBVIOUSLY THE SHOES PROBABLY DIDN'T FIT HIM WELL AND SO HE DEVELOPED AN AREA OF RUBBING THAT BECAME INFECTED, AND A FULL WORKUP SHOWED THAT HE HAD GAS IN HIS TISSUES, ABSCESS AND THEN UNFORTUNATELY OSTEOMYELITIS OF THE SECOND METATARSAL. SO PATIENT HAD TO BE TAKEN TO SURGERY, AND WE DID A PARTIAL FIRST RAY AMPUTATION OR EXCUSE ME PARTIAL SECOND RAY AMPUTATION. HE TOOK PART OF THE METATARSAL, TOOK ALL THE TOE. PART OF THE METATARSAL DOWN TO THE SHAFT, PATIENT WAS PLACED ON EIGHT WEEKS OF IV ANTIBIOTIC THERAPY. ALSO, NEGATIVE PRESSURE WOUND THERAPY WAS UTILIZED TO HELP TO GRANULATE THE AREA IN. AND YOU CAN SEE LONG TERM THIS IS WHAT THE PATIENT LOOKED LIKE. SO TO HIM, HE DIDN'T WANT TO HAVE ANYTHING TOO AGGRESSIVE DONE. HE JUST WANTED THE TOE TAKEN CARE OF, AND WE ARE ABLE TO GET THAT HEALED. IT WAS A LONG ROAD FOR HIM, AND I SUSPECT, HE PROBABLY ENDED UP HAVING PROBLEMS DOWN THE ROAD, I DIDN'T CARE FOR HIM LONG TERM, BUT AT LEAST WE ARE ABLE TO SALVAGE THE MAJORITY OF HIS FOOT, AND GET THAT INITIAL INJURY TO HEAL. NOW THIS PATIENT NEEDS GOOD SHOE GEAR, GOOD MEDICAL SUPPORT, AND PROPER EDUCATION TO KEEP HIM OUT OF HARM'S WAY.