Diabetic foot

Question 1

Risk for diabetic ulcer increases when

Answer 1

> 10yrs
male
poor glycaemic control
already have TOD

Question 2

Critical triad in diabetic foot ulcers

Answer 2

Peripheral sensory neuropathy
Trauma
Deformity

Question 3

Two theories behind diabetic peripheral neuropathy

Answer 3

1. Vascular-decreased blood supply to
the nerves leads to hypoxia of the
nerve.
2. Metabolic-nerve tissue is unique as
it does not require insulin for glucose
to be absorbed into the cells.
Consequently the blood glucose levels
within nerve axons will be directly
proportional to that of blood. Glucose
is then transformed into sorbitol and
fructose which eventually leads to
numerous biochemical and functional
abnormalities.

Question 4

Four factors essential for arthropathy to occur

Answer 4

· Peripheral neuropathy
· Unrecognized injury
· Increased local blood flow.
· Repetitive stress in injured structures

Question 5

How to assess diabetic foot

Answer 5

General exam
Look for comorbidities/TOD
Assess foot (neuropthy, ischaemia, deformity)

Question 6

Vascular tests in diabetic foot

Answer 6

Non-invasive

Ankle brachial index (ABI normal = 0.9-1.1)

Question 7

What can falsely elevate ABI result in diabetes

Answer 7

Medial sclerosis (suggested by dampened waveform)

Question 8

What finding should alert one to infection in the diabetic

Answer 8

Hyperglycaemia

Question 9

On which grading system is treatment of diabetic foot ulcer based

Answer 9

Wagner classification
0 - at risk no ulcer
1 - superficial ulcer
2 - ulcr extension to deeper tissue
3 - ulcer + abscess/ossteomyelitis
4 - local gangrene
5 - Extensive gangrene

Question 10

Antibiotic empiric therapy for limb threatening diabetic ulcer infection

Answer 10

· Penicillin + Gentamycin + Metronidazole.
· Augmentin
· Clindamycin+ Ciprofloxacin