Guide: The International Diabetes Football Working Group (IWGDF) has been updated many times since released the first version of the International Diabetes Foot Clinical Guide in 1999. The Guide’s Formation of Evidence -based Medicine is more practical. Recently, IWGDF has updated the diabetic foot foot Guide, the 2019iWGDF guide includes the prevention and management of diabetes (practical guidelines), the prevention of diabetic ulcer, diagnosis and treatment of diabetic infection with diabetic patients.
Diabetic foot disease is severe in chronic complications of diabetes and high treatment costs. Therefore, we emphasize early prevention to avoid worsening diabetes and foot diseases, causing important health problems. Among them, the related medical problems caused by diabetic foot ulcers are difficult to deal with, and medical expenditures are expensive. Therefore, the editor has compiled the relevant points of the prevention guidelines for diabetic foot ulcers to share with everyone.
For people with low risk of diabetes (IWGDF risk level: 0), the relevant symptoms and signs examination of the lack of protective sensory sensation and screening of peripheral arterial diseases are performed every year to confirm whether their foot ulcer risk increases. (Grade recommendation: strong, evidence quality: high)
For patients with diabetic foot ulcer iWGDF risk levels of 1-3 (foot history ulcers or lower limb amputation history, diagnosis of end-stage nephropathy, there are foot malformations or progress, limited joint activity, foot 胼胝, and any foot ulcer existence Preliminary signs) Strengthen screening: Patients with level 1 of IWGDF risk 1 screen for 6-12 months, patients with level 2 of IWGDF risk 2 every 3-6 months, 1-3 patients at level 3 of IWGDF risk 3 Screening once a month. (Strong, high)
In order to prevent high-risk diabetic patients (IWGDF risk level: 1-3) occur in foot ulcers, it is recommended not to walk barefoot whether it is indoors or outdoors, wearing socks or very thin slippers at the bottom. (Strong, low)
For diabetic patients with risk of uliability of diabetes (IWGDF risk level: 1-3), doctors should guide them to do the following work: check the inside of the feet and shoes every day, and wash their feet every day (carefully dry, pay special attention to drying their toes dry to their toes Silence), moisturize and dry skin with moisturizers, cut the toenails flat, and avoid using chemicals or ointments or any other technologies to remove 胼胝 or chicken eyes. (Strong, low)
Provide structural education for patients with diabetes (IWGDF risk level: 1-3) for diabetic patients with risk of foot ulcer to inform them how to properly carry out their own self-care to prevent foot ulcers. (Strong, low)
Consider guiding patients with diabetic foot ulcers medium and high-risk patients (IWGDF risk level: 2-3) Self-monitoring 1 subcutaneous skin temperature every day to determine any early signs of inflammation of the foot, which helps prevent the occurrence of foot ulcers or recurrence of bottom ulcers. Essence If the skin temperature of two consecutive days in two consecutive days is different and higher than the threshold, activities should be reduced, and professional medical institutions should be further diagnosed and treated as soon as possible. (Weak, medium)
It is recommended that foot ulcer risk moderate (IWGDF risk level: 2) diabetic patients or non -foot -foot ulcers (IWGDF risk level: 3) but patients who have healed, wearing treatment shoes with adaptable foot shapes Stress and help prevent foot ulcers. When the signs before the feet or before the ulcer appear, the doctor should inform the patient that it is best to wear the treatment of shoes, special insoles or toe artifacts. (Strong, low)
When an illusion is required, you can consider the toe silicone or (semi-) rigid appliances. For diabetic patients with high risk (IWGDF risk level: 1-3), it can help reduce the foot of the foot. (Weak, low)
For patients with diabetes with healing of sole ulcers (IWGDF risk level: 3), we can wear treatment shoes with relieving the sole pressure when walking, which can help prevent the recurrence of the sole ulcer. This kind of treatment shoes. (Strong, medium)
Patients with more prefabricated signs of ulcer or more feet need to provide appropriate treatment, such as removing toenails growing to the skin and treating foot fungal infections in the foot to help patients with diabetes (IWGDF risk level level : 1-3). (Strong, low)
Diabetes patients with hammer -like toes, at the same time or abundant or ulcer at the top or far -end cannot be cured by conservative treatment. After considering the healing of active ulcers, the toe flexor tendon cutting can be performed. form. (Weak, low).
Patients with diabetes and underground ulcers but conservative treatment failure can consider Achilles tendon extension, joint forming, single or all -or -be -hop bone head cutting, metatarsal joint formation or bone interception, which will help prevent foot feet. Bottom ulcer recurred. (Weak, low)
We recommend not to use nerve decompression surgery, but should undergo standard foot ulcer care to reduce the ulcer of diabetic patients with medium or high diabetes risk (IWGDF risk grade: 2-3) of those who are experiencing neurological pain. (Weak, low)
Considering that patients with low risk of ulcers or moderate (IWGDF risk level: 1-2) diabetic patients perform exercise exercises related to the foot related to the foot of the foot, such as reducing the peak of the bottom pressure, increasing the foot and ankle of the foot and ankle The scope of exercise is for the purpose of improving neurological symptoms. (Weak, medium) 15
Consider communicating with patients with low or moderate risk (IWGDF risk level: 1-2) diabetes patients to communicate, and an appropriate amount of exercise like walking like walking may be safe (an additional 1,000 steps per day). It is recommended that patients wear appropriate shoes during weight exercises, and often monitor skin temperatures, and pay attention to some signs before ulcers. (Weak, low)
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Providing comprehensive foot -footed care for patients with high risk (IWGDF risk: 3) diabetes patients help prevent recurrence of foot ulcers. These comprehensive foot care include professional foot care, suitable shoes and structural education related to self -care. If necessary, the foot care or evaluation work needs to be re-carried out in 1-3 months. (Strong, low)