糖尿病足と義肢装具：現在の状況と将来の発展

特別企画「Technical & Educational Meeting」
Educational MeetingⅠ
Prosthetics and Orthotics for Diabetic Foot: Current Status and Future Developments
糖尿病足と義肢装具：現在の状況と将来の発展
The Hong Kong Society for Diabetic Limbs Care
香港糖尿足ケア協会
SHUM Wai Hung Anthony, MSc, CPO (HK)
【略
歴】
Prosthetist-Orthotist I
Department of Prosthetics and Orthotics
Princess Margaret Hospital
Hospital Authority Hong Kong
EDUCATION
2008
Master of Science in Health Care (Health Technology)
The Hong Kong Polytechnic University
1994
Professional Diploma in Prosthetics & Orthotics,
School of Prosthetics & Orthotics, Hospital Authority
CERTIFICATION
Certified Prosthetist-Orthotists (Hong Kong) Reg. no. 98-058
Hong Kong Society of Certified Prosthetist-Orthotists CPO (HK)
CPO(HK)
APPOINTMENTS
2013 –Present Prosthetis-Orthotist I Clinical i/c Princess Margaret Hospital
1994-2013
Prosthetis-Orthotist II
Kwong Wah Hospital
MEMBERSHIP IN PROFESSIONAL SOCIETIES
Member (Fellow)
2011- Present
Prof. Development Coordinator (Certification, ethics & informatics)
Hong Kong Society of Certified Prosthetist-Orthotists – CPO (HK)
2009-2011
Vice-President
2003-2009
Executive committee
Member
International Society for Prosthetics & Orthotics (HKNS)
Member
Hong Kong Society for Diabetic Limb Care
Member
Hong Kong Prosthetists and Orthotists Association
Associate Member
Hong Kong Orthopaedic Association
Member
Diabetic Foot Care Service team of Kwong Wah Hospital
since 1995, which is being the first team within Hong Kong
Hospital
Authority
to
establish
and
provide
multidisciplinary foot care service to the diabetic foot
patients with screening, treatment, preventive education
and orthotic management.
【募集定員】
40 名
【講義内容】
Diabetic is a significant public health problem. In Hong Kong, the prevalence of diabetic mellitus is increasing every
year and the majority of lower limb amputation is due to Diabetes Mellitus. This irreversible loss off limb not only
shortens the life span of an individual but also impairs the quality of life. Diabetic foot disease is comprised of foot
ulceration and lower limbs amputation and they are the largest portions of individuals with non-traumatic amputation.
Biomechanics is also an important role in the formation of plantar ulcer. Therefore, prevention of foot ulcer, pressure
off loading and education on proper selection of shoes for the diabetic patient is the major role of the
Prosthetist-Orthotist.
糖尿病は，重大な公衆衛生問題です．香港では，毎年糖尿病の有病率が増加し，下肢切断の主な原因にな
っています．この不可逆的な下肢を失うということは，個人のライフスパンを縮めるだけでなく，QOL(生活
の質)を損なうことにもなります．糖尿病による足病変には，潰瘍や下肢切断があり，これは外傷ではない切
断の多くを占めています．バイオメカニクスも足底の潰瘍形成に重要な役割があります．従って，糖尿病患
者への潰瘍の予防，除圧，正しい靴の選択などに関する教育が義肢装具士の大きな役割になります．
Prosthetic and Orthotic Management of Diabetic Foot
糖尿病足の義肢装具マネージメント

Early identify the at-risk foot (neuropathy, PVD)
リスクにある足の早期鑑別（神経症，末梢循環障害）

Regular follow up (orthotsis checking & plantar pressure analysis)
定期的なフォローアップ（装具士のチェックと足底圧の分析）

Patient education on footwear and self care (not only to patient itself but also to care giver & relative)
履物やセルフケアに関する患者教育（本人だけでなく家族や介護者にも）

Management of ulcer (pre/post/recurrent)
潰瘍の管理（前/後/再発）

Multi-disciplinary collaboration (Orthopedic surgeon, Nurse, Podiatrist…)
チーム医療のコラボレーション（整形外科医，看護師，足専門医など）

Public education on prevention of diabetic foot problems (i.e community talk (foot screening, footwear inspection)
and cooperate with NGOs)
糖尿病足の問題を予防することへの公衆教育（コミュニティートーク(足部のスクリーニング，履物の点
検)NGO と協力など）
IWGDF 2011: Practical Guidelines on the Management & Prevention of the Diabetic Foot
国際糖尿病足ワーキンググループ 2011：糖尿病足の管理と予防に関する実践的なガイドライン
•
Mechanical off-loading- the cornerstone in ulcers with increased biomechanical stress
バイオメカニカルなストレスの増加による潰瘍の根本へのメカニカルな除圧
•
TCC / other casting techniques- preferable in the management of plantar ulcers
トータルコンタクト，そのほかのキャスティングテクニック‐足底の潰瘍の管理に好ましい
•
Temporary footwear
一時的な履物
•
Individually molded insoles & fitted shoes
個別にモールドされたインソールと適合された靴
–
Non-weighting (limitation of standing, walking & use crutches)
体重をかけない（制限のある立位，歩行，杖の使用）
Common Methods to “Off-Load” the Foot
足部を“免荷”する一般的な方法
•
Best rest
最良の休息
•
Wheel Chair
車いす
•
Crutch Assisted Gait
杖歩行
•
“Half Shoe” / post surgical shoe
“半分の靴”/術後の靴
•
Total Contact Cast
トータルコンタクトキャスト
•
Orthotic Shoe / insole
整形外科靴/インソール
•
Custom Splints
カスタムスプリント
•
Removable Cast Walker
取り外しキャストウォーカー

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