Diabetic Foot Flashcards
How do diabetic foot ulcer’s occur?
- 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
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What percentage of diabetics will develop ulceration?
15%
What are the modifiable determinants of healing of a diabetic foot ulcer?
- Diabetic control
- Smoking
- Vascular supply
- External pressure modification
- Internal pressure (deformity)
- Infection
- Nutrition
What is the 5 year mortality for those who develop diabetic foot ulcers?
50%
What percentage of those that develop diabetic foot ulcers go on to have the foot amputated?
25%
What is Charcot’s arthropathy?
Progressive degeneration of a weight bearing joint, a process marked by bony destruction, bone resorption, and eventual deformity.
What is the following?
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Diabetic Foot Ulcer - Complication of diabetes
The following deformity was found in someone with diabetes. What is the name of this deformity?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/267/561/204/q_image_thumb.jpg?1517596261)
Charcot’s Foot
What are thought to be the processes behind the development of Charcot’s Arthropathy?
- 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.
What can Charcot’s foot lead to?
Osteomyelitis - Chronic deformation may lead to repetitive trauma of the mid-foot (arch) during walking, leading to ulceration in this area
If someone had signs of a septic diabetic foot ulcer, what tests would you do?
- Probe to bone - check for osteomyelitis
- Swab +/- tissue biopsy
- Plain X-ray +/- MRI
What does being able to “probe to bone” indicate in someone with a diabetic foot ulcer?
Route for infection to get into bone
What is the first line antibiotic used for diabetic foot ulcer?
- Non-septic - IV fluclox
- Septic - Tazocin
What preventative measures can be taken to attempt to reduce the risk of developing a diabetic foot ulcer?
- Effective patient education
- Risk factor reduction
- Regular patient review
How would you manage a diabetic foot ulcer?
- Risk factor management
- Wound care
- Minimise neuropathy
- Treat peripheral ischaemia