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| Patients
with various diabetic complications are referred to our centre . Our centre
is one of the largest diabetic centres in Asia. The foot care department
of our centre is actively involved in the treatment and research of diagnostic
foot problems. The services and facilities available are given in the following
paragraphs |
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| Introduction |
| The Diabetic Foot Clinic of M.V.Hospital for Diabetes, Royapuram called
M.V.Centre for Diabetic Foot Care, Podiatry, Research and Management, provides
routine integrated examination for diabetic patients. The services of the clinic
include education of the patient in practical aspects of foot care, the early
recognition of foot at risk, special advice on selection of footwear, and providing
a comprehensive care for all diabetic foot complications |
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| Staffing Pattern |
| Managing Director |
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Dr.
Vijay Viswanathan, MD. Ph.D, FRCP (London)
FRCP (Glasgow) |
| Podiatric Surgeon |
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Dr. Rajesh Kesavan |
| General Surgeons |
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Dr. R. Venkatagopalakrishnan, Dr. Jacob |
| Vascular Surgeons
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Dr. Rajkumar, Dr. Ilayakumar |
| Orthopedic Surgeons |
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Dr. S. Chandrasekaran, Dr. Aravind |
| Plastic Surgeons |
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Dr. Praveen / Dr. T.M. Balakrishnan |
| Podiatry Nurses |
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Dr.
Mrs. Sarala, Mrs. Jhansi |
Podiatric assistant /
Physiotherapist |
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Mrs. Bamila |
| Foot Educator |
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Mrs. Seena Rajasekar |
| Pedicurists |
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Ms.Karpagaselvi |
| Supervisor |
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Mr. Mohammed Rafi |
| Orthotist |
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Mr. John |
| Shoe Makers |
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Mr. Raghupathy, Mr. Babu, Mr. Yuvaraj |
| Footwear Assistant |
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Mr. Jeevarathinam |
| Foot lab technicians |
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Ms.Rekha, Ms.Shalini |
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| FACILITIES
& SERVICE |
The clinic has the required facilities and staff to provide the following
services.
(a) Education of Patients & Carers,
(b) Timely detection of high risk foot through routine foot examination by
specially trained staff capable of recognizing risk factors for ulceration and
amputation,
(c) Measures to reduce risk, including Chiropody, appropriate footwear and
vascular and orthopedic interventions,
(d) Prompt and effective treatment of active problems, including ulcers, infection
and ischemia. |
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| Scope and Activities
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| The Clinic emphasizes that most of the complications are preventable with adequate education, routine foot care and attention to footwear, early detection followed by specific advice and treatment. The services offered by the Clinic provide the best opportunity to prevent complications resulting in amputations. The Foot Clinic includes the following moder units with state of the art facilities. |
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| 1. Foot Laboratory
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Foot Laboratory provides the following services.
(i) Doppler Studies – These non-invasive
vascular tests can be used for:
(a) diagnosis and quantification of PVD (Peripheral Vascular Disease)
(b) predicting wound healing of a
diabetic foot ulcer
(c) follow-up and control of treatment
(d) Colour Doppler (Duplex) scan to study the extent and severity of PVD
and to aid the vascular surgeon to decide
about management.
(ii) Biothesiometry Test (BT Test) –
This
study is done using a small electronic
instrument to determine vibration perception.
These tests have been shown to be a good
indicator of diabetic neuropathy.
(iii) Monofilament Test –
10g monofilament is
used for this test. Inability to perceive the 10g
monofilament at the toes or dorsum of the
foot predicts future occurrence of a diabetic
foot ulcer. |
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| DIASTEP™
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| This branded off the shelf footwear is the research product of M.V.Hospital for Diabetes and the Central Leather Research Institute, Chennai, supported by Novo Nordisk Educational Foundation. It is specially designed for diabetic patients who have neuropathy, minor foot deformation and have developed minor foot complications earlier.. |
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| Its special features are:
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PU sole with extra depth for more effective pressure distribution
The extra depth sole has a special tread for better grip and traction
Specially designed insole bed and foam layer for added comfort
Rigid counter to ensure limited joint mobility
Specially designed upper with leather lining for comfortable wear
Adjustable Velcro fasteners to take care fluctuations
in foot volume
Apart from these features, a specially derived
angle of slant has been provided in the sole to
give the rocker effect which is used to offload
pressure from planter surface of the feet.
All these features incorporated after considerable research and after testing on
people with Diabetes Mellitus at MV Hospital for Diabetes, Royapuram, Chennai
make DIASTEPTM footwear an essential item for people with diabetes. Constant
wear of this footwear will prevent foot ulcers and foot infection.
(iv) Nerve Conduction Studies
Slowing of Nerve Conduction Velocity is one
of the earliest neuropathic abnormalities in Diabetes Mellitus. Early diagnosis of
Diabetic Peripheral Neuropathy is necessary to prevent
fissure formation, infection and ulceration of the feet.
In recent years, a number of Electro Physiological
testing methods have been developed for early
detection and diagnosis of Diabetic Neuropathies.
These tests quantify nerve conduction and
help to localize the lesions. These studies are
carried out by this department.
(vi) Tip Therm
This instrument determines
the thermal perception in the nerve endings,
measuring warm and cold perception separately.
This quantitative measurement helps an early
diagnosis and staging of neuropathy. |
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| 2. Foot Care Education
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All patients with foot complications are educated by the Foot Care Educator
regarding:
(a) General principles of Foot Care like nail cutting, cleanliness of the foot, fungal
infection between the toes and the heel fissures.
(b) Knowledge about the right type of footwear and also the importance of wearing them. Patients are also provided with books and pamphlets.
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| 3. Pedicure Unit
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Plantar aspect of the foot is examined by the Pedicurist for the presence of potential foot problems like heel fissures, in-growing toe nails, callus, dry skin, etc. Foot cleaning is taught along with nail filing.
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| 4. In-house Footwear manufacturing unit
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Proper footwear is one of the most important aspects of preventive foot care.
New types of footwear are now being prepared at M.V. Hospital, Royapuram with technical assistance from Central Leather Research Institute, (CLRI) Chennai, for diabetic patients with foot complications. Patients in risk category 0,1 (low risk) are provided comfortable footwear made of good
insole materials. These patterns are more attractive & acceptable to the patients, than the conventional
MCR footwear. Patients in risk category 2, 3 (high risk) are given custom-made footwear. Those patients with previous ulceration, foot deformity are given custom made footwear with moulded insole.
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| New Equipment To Prepare Customised Insoles
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| Electronic Baropedometer
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Foot ulceration in persons with diabetes is the frequent causes for amputation. Several studies have shown that the regular wear of therapeutic footwear, foot
education, and diabetic foot care, prevents ulceration, reduces re-ulceration and amputation. Apart from these, Customized insoles are prescribed to offload
high pressures from the metatarsal heads and from other areas, which helps in reducing the risk of plantar ulceration. The M.V. Hospital for Diabetes has introduced a new equipment, the ELECTRONIC BAROPEDOMETER to prepare customized therapeutic insoles.
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| Electronic podometer is used to evaluate in an accurate way the
following parameters
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Examination in standing position
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• Pressure distribution in orthostatic condition
• Stabilometry of the patient in static position
• Dynamic evolution of the pressure during the dynamic phase of step
• Peaks of pressures and time of contact on the ground
• Individualization of areas at risk for the foot
• Comparison of the results of therapies adopted in time
• Helps in the design of plantar orthesis.
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| Different steps in preparing customized insoles
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Identify the pathology
Select treatment
Make a customized insoles |
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| Luminoscope Qualitative Analysis |
Electronic platform or podoscope
(footwork)-for static and dynamic analysis |
Moulding Procedure |
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| Samples of Modular insoles |
A fully prepared customized insole |
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| 5. Surgical Care
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A dedicated team of, general, podiatry, vascular, plastic and orthopedic surgeons
provide surgical care for patients requiring operative care of their diabetic foot infection. Patients referred to our hospital are given prompt surgical care and measures are taken to ensure limb salvage to the extent possible.
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