Diabetic Foot

Question 1

Inspect

Answer 1

Walking aids Bilateral signs of chronic arterial disease - hair loss, dry, colour of skin - pallor/ erythema Amputations: esp. digits Charcot joints Ulceration - look in between toes, lift up legs

Question 2

Palpate

Answer 2

Temperature - PVD, cellulitis Cap refill Pulses may be preserved due to calcification ↓ sensation in stocking distribution

Question 3

Completion

Answer 3

Examine the peripheral nervous system - vibration, monofilament, reflexes, proprioreception Gait Check footwear for uneven wear Urinalysis: proteinuria Fundoscopy: retinopathy ABPI, cap glucose, doppler, hba1c

Question 4

History

Answer 4

Control Complications Claudication Previous operations Other vascular disease Other vascular risk factors

Question 5

Diabetic foot syndrome

Answer 5

Micro and microvascular disease Predominantly below knee cf. non-DM occlusive disease. Neuropathy Infection and osteomyelitis

Question 6

Aetiology of diabetic ulcers

Answer 6

Neuropathic: 45-60% Ischaemic: 10% Mixed neuroischaemic: 25-45%

Question 7

How do diabetics preserve pulses

Answer 7

Calcification in the walls of the vessels: mediasclerosis Preserves the pulses until late → abnormally high ABPI Use toe pressure instead: <30mmHg Similar effect is seen in CRF

Question 8

Problems c ̄ Diabetics Undergoing Angiography

Answer 8

Often have a degree of renal impairment which can be dramatically worsened ̄c contrast agents. Metformin must be stopped prior to the procedure to prevent lactic acidosis

Question 9

Venous vs ischaemic vs neuropathic ulcer

Answer 9

Question 10

What is charcot joint?

Rx?

Answer 10

Charcot arthropathy results in progressive destruction of bone and soft tissues at weightbearing joints; in its most severe form, it may cause significant disruption of the bony architecture

Good control of diabetes is essential to prevent progression of the neuropathy.

Boot and no weight bearing

Podiatry

Bisphosphonates

Surgery