psychosocial aspect of diabetic foot

1. PSYCHOSOCIALPSYCHOSOCIAL
ASPECT OF DIABETICASPECT OF DIABETIC
FOOTFOOT
DR.ARUN BALDR.ARUN BAL
PRESIDENTPRESIDENT
DIABETIC FOOT SOCIETY OFDIABETIC FOOT SOCIETY OF
INDIAINDIA

2. FOOT ULCERATION AND HIGHER LEVEL AMPUTATION RATE STILL
UNACCEPTABLY HIGH INSPITE OF TECHNOLOGICAL ADVANCES
FOCUS ON PHYSICAL FACTORS HAS NOT REDUCED THE COMPLICATIONS
OF DIABETIC FOOT
IT IS IMPORTANT TO ANALYSE THE PATIENT`S PERCEPTION AND THREATS
PERCEIVED BY HIM REGARDING HIS PROBLEM
PRESCRIPTION OF PHYSICAL THERAPEUTIC MODALITIES LIKE OFF
LOADING HAVE NO PSYCHOSOCIAL ASSESSMENT
QUALITY OF LIFE IS USUALLY NOT AN IMPORTANT COMPONENT OF
THERAPEUTIC MODALITIES IN DIABETIC FOOT COMPLICATION
WHY PSYCHOLOGICAL ASPECTS
OF DIABETIC ARE IMPORTANT?

3. QUALITY OF LIFE INQUALITY OF LIFE IN
DIABETIC NEUROPATHYDIABETIC NEUROPATHY
• WORSENING OF PHYSICAL &WORSENING OF PHYSICAL &
PSYCHOSOCIAL FUNCTIONINGPSYCHOSOCIAL FUNCTIONING
• NEGATIVE IMPACFT ON QUALITY OF LIFENEGATIVE IMPACFT ON QUALITY OF LIFE
• QUALITY OF LIFE IS NOT MERE HEALTHQUALITY OF LIFE IS NOT MERE HEALTH
STATUS BUT PT.`S PERCEPTION OF HISSTATUS BUT PT.`S PERCEPTION OF HIS
HEALTHHEALTH
• WORSENING PHYSICALWORSENING PHYSICAL
ACTIVITY/AMPUTATION CAUSESACTIVITY/AMPUTATION CAUSES
REDUCTION IN SELF ESTEEM/SELF IMAGEREDUCTION IN SELF ESTEEM/SELF IMAGE
• CONCEPT OFNEUROPATHY QUALITY OFCONCEPT OFNEUROPATHY QUALITY OF
LIFELIFE

4. QUALITY OF LIFE INQUALITY OF LIFE IN
DIABETIC NEUROPATHYDIABETIC NEUROPATHY
• REASONS FOR REDUCED QUALITY OFREASONS FOR REDUCED QUALITY OF
LIFE:LIFE:
• PAIN/PAIN/
• LOSS OF SENSATIONLOSS OF SENSATION
• UNSTEADINESSUNSTEADINESS
• BEING TREATED DIFFERENTLYBEING TREATED DIFFERENTLY
• DN SPECOFIC SCALE FOR QOL ISDN SPECOFIC SCALE FOR QOL IS
PREDICTOR OF EMOTIONAL BURDENPREDICTOR OF EMOTIONAL BURDEN

5. CONCEPT OFCONCEPT OF
HEALTH RELATEDHEALTH RELATED
QUALITY OF LIFEQUALITY OF LIFE

6. PSYCHOSOCIAL FACTORS WHICHPSYCHOSOCIAL FACTORS WHICH
LEAD TO REDUCED SELF FOOTLEAD TO REDUCED SELF FOOT
CARECARE
• PAST BELEIFS ABOUT SELF CAREPAST BELEIFS ABOUT SELF CARE
• BELIEF ABOUT ABILITY TO PERFORMSELFBELIEF ABOUT ABILITY TO PERFORMSELF
CARECARE
• CONCERRN ABOUT POTENTIAL RISK OFCONCERRN ABOUT POTENTIAL RISK OF
AMPUTATIONAMPUTATION
• WILLINGNESS TO WEAR SPECIAL FOOTWILLINGNESS TO WEAR SPECIAL FOOT
WEARWEAR
COSMETIC ACCEPTIBILITY,COSMETIC ACCEPTIBILITY,
COSTCOST
AVAILABILITYAVAILABILITY

7. PSYCHOLOGICAL EFFECTSPSYCHOLOGICAL EFFECTS
OF ROUTINE FOOTOF ROUTINE FOOT
EXAMINATIONEXAMINATION
• REINFORCES IMPORTANCE OF CONCEPTREINFORCES IMPORTANCE OF CONCEPT
OF TISSUE INTEGRITYOF TISSUE INTEGRITY
• REINFORCES PATIENTS AWARENES ABOUTREINFORCES PATIENTS AWARENES ABOUT
SENSORY DEFECITSENSORY DEFECIT
• DEMONSTRATES AREAS OF REDUCEDDEMONSTRATES AREAS OF REDUCED
SENSATION TO THE PATIENTSENSATION TO THE PATIENT
• ACCEPTANCE OF THE CONCEPT OF SELFACCEPTANCE OF THE CONCEPT OF SELF
CARE FOR DIABETIC FOOTCARE FOR DIABETIC FOOT
• YEILDS LONG TERM PSYCHOLOGICALYEILDS LONG TERM PSYCHOLOGICAL
BENEFITSBENEFITS

8. SOCIAL ASPECTS OFSOCIAL ASPECTS OF
DIABETIC FOOTDIABETIC FOOT
SURGERYSURGERY
• MAJORITY ELDERLYMAJORITY ELDERLY
PATIENTSPATIENTS
• NUCLEAR FAMILIESNUCLEAR FAMILIES
• LACK OF ACCOMODATIONLACK OF ACCOMODATION
• LACK OF OPTIMAL SANITARYLACK OF OPTIMAL SANITARY
FACILITYFACILITY
• COST OF THE TREATMENTCOST OF THE TREATMENT
Dr.bal

9. SOCIAL ASPECTS OFSOCIAL ASPECTS OF
DIABETIC FOOTDIABETIC FOOT
SURGERYSURGERY
• DISPOSAL OF BIO HAZARDOUSDISPOSAL OF BIO HAZARDOUS
WASTEWASTE
• LACK OF DOMICIALLARYLACK OF DOMICIALLARY
DRESSING FACILITYDRESSING FACILITY
• LOSS OF JOBLOSS OF JOB
• PERMANENT DISABILITYPERMANENT DISABILITY
• LACK OF FOOTWEAR FACILITYLACK OF FOOTWEAR FACILITY
Dr.bal

10. PSYCHOLOGICAL FACTORSPSYCHOLOGICAL FACTORS
ASSOCIATED WITH DIABETICASSOCIATED WITH DIABETIC
FOOTFOOT
• INCREASEDINCREASED
• DepressionDepression
• divorce ratedivorce rate
• alcohol abusealcohol abuse
• disruption indisruption in
social,domesticsocial,domestic
environmentenvironment
• negative attitudenegative attitude
• DECREASEDDECREASED
• diabetic self carediabetic self care
• psychologicalpsychological
adjustment to illnessadjustment to illness
• social/family supportsocial/family support
• self esteemself esteem
• quality of lifequality of life
• satisfaction withsatisfaction with
treatmenttreatment
Dr.bal

11. FOOT ULCERSFOOT ULCERS
PSYCHOLOGICAL BEHAVIORALPSYCHOLOGICAL BEHAVIORAL
FACTORSFACTORS
• IDENTITYIDENTITY
• TIMELINETIMELINE
• CONSEQUENCESCONSEQUENCES
• CAUSECAUSE
• CONTROLCONTROL

12. REDUCINGREDUCING
DISSATISFACTION ISDISSATISFACTION IS
MORE IMPORTANTMORE IMPORTANT
THAN INCREASINGTHAN INCREASING
SATISFACTION FORSATISFACTION FOR
IMPROVING QUALITYIMPROVING QUALITY
OF LIFEOF LIFE

13. MECHANISM OFMECHANISM OF
DEPRESSION IN DIABETICDEPRESSION IN DIABETIC
NEUROPATHYNEUROPATHY
• DIRECTDIRECT
PTS REALIZATION THAT THE ILLNESSPTS REALIZATION THAT THE ILLNESS
IS UNCHANGEABLE PART OF LIFEIS UNCHANGEABLE PART OF LIFE
COMBINED WITH PAIN/UNSTEADINESSCOMBINED WITH PAIN/UNSTEADINESS
SENSE
OF
HELPLESSNESS
DEPRESSION

14. MECHANISM OFMECHANISM OF
DEPRESSION IN DIABETICDEPRESSION IN DIABETIC
NEUROPATHYNEUROPATHY
SELF PERCEPTION AS FAMILY BURDEN
LOSS OF SELF ESTEEM AND CONFIDENCE
• INDIRECTINDIRECTPHYSICAL AND SOCIAL DYSFUNCTION
DEPRESSION
REDUCED SELF CARE
ULCER

15. WHAT NEEDS TO BE DONE ?WHAT NEEDS TO BE DONE ?
• ROUTINE PSYCHOLOGICAL ASSESSMENT OF ALLROUTINE PSYCHOLOGICAL ASSESSMENT OF ALL
DIABETIC FOOT PATIENTSDIABETIC FOOT PATIENTS
• PSYCHOLOGIST/MEDICAL SOCIAL WORKER TO BEPSYCHOLOGIST/MEDICAL SOCIAL WORKER TO BE
MEMBER OF THE TEAMMEMBER OF THE TEAM
• COMMUNICATION TRAINING FOR PARAMEDICSCOMMUNICATION TRAINING FOR PARAMEDICS
AND DOCTORS.AND DOCTORS.
• RESEARCH IN PSYCHOSOCIAL ASPECTS IN INDIARESEARCH IN PSYCHOSOCIAL ASPECTS IN INDIA
• INVOLVEMENT OF DEPT.OFINVOLVEMENT OF DEPT.OF
PSYCHOLOGY/SOCIALOGY FROM TEACHINGPSYCHOLOGY/SOCIALOGY FROM TEACHING
INSTITUTESINSTITUTES

16. MEDICOLEGAL ASPECTSMEDICOLEGAL ASPECTS
OF DIABETIC FOOTOF DIABETIC FOOT
SURGERYSURGERY
• DODO
• PT EDUCATIONPT EDUCATION
• DOCUMENTATIONDOCUMENTATION
• FOLLOW UPFOLLOW UP
• AGGRESSIVEAGGRESSIVE
TREATMENTTREATMENT
• REFER TOREFER TO
EXPERTSEXPERTS
• DONTDONT
• TREAT IF IN DOUBTTREAT IF IN DOUBT
• IF NOT WITHINIF NOT WITHIN
YOUR FIELDYOUR FIELD
• DELAY TREATMENTDELAY TREATMENT
• LET PT.GO UNLET PT.GO UN
TREATEDTREATED
Dr.bal

17. THANK YOUTHANK YOU