Evaluation and Treatment of Diabetic Neuroarthropathy - Medical ...

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Etiology Neuropathy symmetrical > asymmetrical sensory fibers > autonomics distally accentuated loss of myelinated and unmyelinated fibers electrophys. studies indicate axonal loss sensory and/or motor Dyck, et al: Neurology 43: 1993
Neuropathy metabolic contribution: hyperglycemia results in: accumulation of sorbitol; ↓ myo-inositol; conduction block of myelinated axons vascular contribution: extraneural A-V shunting; hypoxia narrowed capillary/arteriolar lumens poor regulation of microcirculation
Page 1 and 2: Evaluation & Treatment of Diabetic
Page 3 and 4: Objectives • discuss the musculos
Page 5 and 6: Diabetes; the “giving” disease
Page 7 and 8: Diabetes mellitus Epidemiology >65
Page 9: Neuropathy Epidemiology associated
Page 13 and 14: Neuropathy Autonomic dysfunction: a
Page 15 and 16: Neuropathy Immune dysfunction: maln
Page 17 and 18: Neuropathy treatment • maximize g
Page 19 and 20: Diabetic foot ulcer Epidemiology 15
Page 21: Ulcer formation pressure + neuropat
Page 24 and 25: depth Ulcer classification 0: “at
Page 26: Mechanical, structural factors •
Page 30 and 31: Sensation Monofilament testing 5.07
Page 32 and 33: Circulation Waveform characteristic
Page 34 and 35: Infection • screening labs CBC, E
Page 36 and 37: Infection
Page 38 and 39: Healing potential Screening labs to
Page 40 and 41: Off-loading • pressure prevents u
Page 42 and 43: Total contact cast
Page 44 and 45: Protection
Page 46 and 47: Exostectomy
Page 48 and 49: Exostectomy
Page 50 and 51: Reconstruction
Page 52 and 53: Neuroarthropathy • Jean-Martin Ch
Page 54 and 55: Neuroarthropathy Typical scenario i
Page 58 and 59: Neuroarthropathy • “no ulcer -
Page 60 and 61:
Neuroarthropathy “at-risk” fact
Page 62 and 63:
Etiology Neurovascular theory neura
Page 64:
stage I Charcot • x-ray: fragment
Page 67 and 68:
stage III Charcot • x-ray: recons
Page 69 and 70:
Neuroarthropathy Treatment goals cr
Page 71 and 72:
Charcot acute treatment • strict
Page 73 and 74:
Stage II treatment • protected we
Page 76:
Surgical indications • gross inst
Page 82 and 83:
Amputation Epidemiology 20X higher
Page 84:
Limb salvage vs. amputation • wil
Page 87 and 88:
Conclusions Ulcer treatment pressur
Page 89 and 90:
Conclusions Charcot treatment redne
Page 91 and 92:
Vascular Endocrine Orthopedics Woun
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