Diabetic Foot

Question 1

What is diabetic foot?

Answer 1

Complications in the feet as a result of diabetes

Question 2

What are the most serious complications?

Answer 2

• Ulceration Neuropathy (sensory, motor, autonomic)
• Infection

Question 3

What are the risk factors for ulceration?

Answer 3

• Previous ulceration Neuropathy (stocking distribution & Charcot joint)
• PVD
• Altered foot shape
• Callus (indicates high foot pressures)
• Visual impairment
• Living alone Renal impairment

Question 4

Describe pure neuropathic ulceration

Answer 4

• Warm foot with palpable pulses
• Evidence of sensory loss, leading to unrecognised repeated local trauma
• Normal or high duplex flow

Question 5

Describe ischaemic/ neuro-ischaemic ulceration

Answer 5

• Foot may be cool
• Absent pulses
• Ulcers commonly on toes, heel or metatarsal head
• Secondary infection may be present with minimal pus and mild surrounding cellulitis
• ABPIs may be high

Question 6

Outline the prophylactic treatment for diabetic foot

Answer 6

Prophylactic management

• Control of risk factors
• Regular foot inspection
• Wide fitting footwear
• Nail care with chirpodist
• Keep away from heat
• Do not walk bearfoot

Question 7

Outline the treatment for established ischaemic ulceration

Answer 7

• Treat local/ systemic infection
  
  • Broad-spectrum antibiotics (local guidelines)
  • Debride obviously dead tissue, inc digital amputation
  • Drain pus
  • X-Ray for underlying osteomyelitis
• Revascularization
  
  • Angioplasty
  • Femoro-distal bypass grafts
• Amputation