Diabetic Foot

Question 1

How do diabetic foot ulcer’s occur?

Answer 1

• Diabetic neuropathy - patient unaware of trauma + dry cracked skin due to lack of sweat
• Skin more sensitive to minor trauma
• Poor vascular supply - impairs healing process

Question 3

What percentage of diabetics will develop ulceration?

Answer 3

15%

Question 4

What are the modifiable determinants of healing of a diabetic foot ulcer?

Answer 4

• Diabetic control
• Smoking
• Vascular supply
• External pressure modification
• Internal pressure (deformity)
• Infection
• Nutrition

Question 5

What is the 5 year mortality for those who develop diabetic foot ulcers?

Answer 5

50%

Question 6

What percentage of those that develop diabetic foot ulcers go on to have the foot amputated?

Answer 6

25%

Question 7

What is Charcot’s arthropathy?

Answer 7

Progressive degeneration of a weight bearing joint, a process marked by bony destruction, bone resorption, and eventual deformity.

Question 8

What is the following?

Answer 8

Diabetic Foot Ulcer - Complication of diabetes

Question 9

The following deformity was found in someone with diabetes. What is the name of this deformity?

Answer 9

Charcot’s Foot

Question 10

What are thought to be the processes behind the development of Charcot’s Arthropathy?

Answer 10

• Neurotrauma: Loss of peripheral sensation and proprioception ⇒ repetitive microtrauma ⇒ resultant inflammatory resorption of traumatized bone leaves region weak and susceptible to further trauma.
• Neurovascular: Dysregulated autonomic nervous system reflexes, and de-sensitized joints receive significantly greater blood flow ⇒ Resultant hyperemia leads to increased osteoclast resorption. This, in addition to mechanical stress, leads to bony destruction.

Question 13

What can Charcot’s foot lead to?

Answer 13

Osteomyelitis - Chronic deformation may lead to repetitive trauma of the mid-foot (arch) during walking, leading to ulceration in this area

Question 14

If someone had signs of a septic diabetic foot ulcer, what tests would you do?

Answer 14

• Probe to bone - check for osteomyelitis
• Swab +/- tissue biopsy
• Plain X-ray +/- MRI

Question 15

What does being able to “probe to bone” indicate in someone with a diabetic foot ulcer?

Answer 15

Route for infection to get into bone

Question 16

What is the first line antibiotic used for diabetic foot ulcer?

Answer 16

• Non-septic - IV fluclox
• Septic - Tazocin

Question 17

What preventative measures can be taken to attempt to reduce the risk of developing a diabetic foot ulcer?

Answer 17

• Effective patient education
• Risk factor reduction
• Regular patient review

Question 18

How would you manage a diabetic foot ulcer?

Answer 18

• Risk factor management
• Wound care
• Minimise neuropathy
• Treat peripheral ischaemia