Diabetic foot Flashcards
5 Presentations of diabetic foot?
Ulcer
Cellulitis, necrotising fasciitis
Gangrene
Infection
Charcot joint disease
Wagner classification?
0 - no ulcer
1 - superficial ulcer involving only skin
2- superficial ulcer involving muscle/ligs/bone
3 - deep ulcer involving abscess/tendinitis/OM
4 - Forefoot or toe gangrene
5 - Midfoot or hindfoot gangrene
What is Charcot arthropathy
Chronic progressive degeneration of a weight bearing joint causing deformity of bone architecture and joint alignment.
Causes of Charcot’s joint
Diabetes
Neurological -
Rheumatological
Toxins - alcoholism
Infection - leprosy, poliomyelitis, syphilis, tabes dorsalis
How to differentiate Charcot’s arthropathy with cellulitis and OM?
In Charcot’s, redness typically resolves with elevation
Brodsky’s classification for Charcot Joint?
1 = Tarsometatarsal joint Midfoot
2 = Subtalar joint hindfoot
3a = Ankle joint
3b = Calcaneal tuberosity fracture
4 = Any combination
5 = Forefoot
Lifetime risk for DFU btw ___ and ___%.
High recurrence ___% within 1yr, ___ at 3 years, ___% 5 years after healing.
Lifetime risk for DFU btw 19 and 34%.
High recurrence 40% within 1yr, 60% at 3 yrs, 65% 5 yrs after healing.
Diabetics ___ ~ ___ times higher risk of amputation.
___% 5 yr mortality post LL amputation.
Diabetics 15 ~ 31x risk of LL amputation
50% 5yr mortality post LL amputation.
3 zones in debridement of diabetic foot?
Red zone of actual injury/ulcer
Orange zone of inflammation
Green zone of clean tissue
Why must turgish foot with normal looking skin be checked?
Epidermis of plantar skin in sole of foot seals up v fast. Hence pathology can hide below it.
OM changes show up after _____ weeks
4-6 weeks
What to remember XR for all diabetic foot or foot in general?
must do WEIGHT BEARING XR!
____ of pts with current foot ulcer develop SSI. Of these, ____% go into OM.
50% of pts with current foot ulcer develop soft tissue infection. 20% of these go onto OM.
Implication of low toe pressure in pharmacological treatment?
Abx administered vascularly cannot reach target tissue in foot. Hence must have good collaterals.
Some characteristics of Diabetic foot
- May not have early symptoms
- Somatic/autonomic neuropathy
- May not have typical features of PAD
- Immune paresis = downregulation of host defences with signs of broad inflamm
Some ways of enhancing healing of chronic foot ulcers?
Maggot therapy, skin graft, sharp debridement (best) etc etc
Commonest area of mid foot ulcer?
Cuboid area in plantar side
Classify causes of callus?
Static and dynamic causes - generally abnormal pressure distribution
What does Charcot-Marie-Foot disease commonly cause? And why?
Cavus foot.
Imbalance involving intrinsic and extrinsic muscles
Foot muscles can be split into _____ and _____ muscles. The ____ foot muscles are found in the lower leg and act to dorsiflex, plantarflex, invert and evert the foot. The _____ foot muscles are entirely contained within it, and primarily act to move the ____
Foot muscles can be split into extrinsic and intrinsic muscles. The extrinsic foot muscles are found in the lower leg and act to dorsiflex, plantarflex, invert and evert the foot. The intrinsic foot muscles are entirely contained within it, and primarily act to move the toes
Best Tx of Charcot’s?
Total contact cast. Can be done closed or open toe. It reduces edema and distribute pressure from foot to lower leg, helps swelling come down.
Alternative Tx of Charcot’s for pts with poor vascularization?
Walker boot for those with poor vascularization, but TCC alw better for acute phase
What is the issue with increasingly proximal amputations?
OTher than aesthetics, metabolic cost of walking rises.
When metabolic cost is too high, pt likely cant walk again
Foot amp levels?
Syme, Chopart, Lysfranc, transmetatarsal
Why is BKA not recommended for bedbound pts?
Poor wound healing due to stump pressing on bed
Ideal BKA landmark?
10-12cm from tibial tuberosity, 12-15cm from knee joint
BKA prosthesis is weight-borne by?
Patella
AKA ideal landmark?
12cm above knee joint. To allow prosthetic fitting
Downside of AKA for prosthetics?
Cuz AKA leaves no knee joint, prosthetic is bulkier and weight is borne by ischial tuberosity, making movement harder. E.g. pt struggles to sit down (improved with recent technical developments)
What bears weight for AKA prosthetics?
Ischial tuberosity
