Diabetic foot

Question 1

What is Diabetic foot?

Answer 1

Foot infection of any degree in a pt with known DM/ Clinical features

Question 2

Pathophysiology

Answer 2

Ulceration of the foot that mediates entry of bacteria through:
1. Neuropathy
-Sensory (minor traumas)
-Motor (Architecture changes)
-Autonomid dessication
2. Immunopathy
- Glycosylation in the leukocytes: Lazy leukocyte syndrome
- Reduced cell mediated immunity (Poir cross-linkage of filamentary cells)=>impedes diapedesis
-The thickened basement membrane + impedes diapedesis
3. Vasculipathy
- vessels mostly affected:
Iliac a., tibial a., dorsalis pedis
PVD=>coagulative liquefactive necrosis of the tips of the digits or dorsum of the foot

Question 3

Classification

Answer 3

Although I have tools to assess, what I see is not always what I get when I go to clean up the foot. That is why diapetic foot should be managed as inpatient
Superficial: Debridement +ABX
Interstitial: Cellulitis, tracking along tendons or tendon related abscesses =>Debridement lay open esp of the plantar aspect
Deep: seated abscess, gas gangrene and osteomyelitis => often leads to amputations0