Diabetic Foot Flashcards
What makes up nearly 50% of all diabetes-related hospital admissions?
Diabetic foot problems
What is the most common cause of non-traumatic lower limb amputation.
Diabetes
Explain how vascular problems might cause diabetic foot.
Ischaemia from peripheral vascular disease and diabetes compromises the ability to heal after minor trauma or infection.
What are the two types of diabetic foot?
Neuropathic diabetic foot.
Vascular diabetic foot.
Explain neuropathic diabetic foot.
Pain is protective, if it fails the patient won’t experience trauma as much. They might walk on a wounded foot and exacerbate the problem and cause it to never heal.
Autonomic neuropathy also reduces sweating and alters blood flow resulting in dry skin prone to cracks and fissures.
What is charchot arthropathy a complication of?
Severe neuropathy
Three phases of Charcot arthropathy.
It occurs in a well-perfused foot.
1 - Acute onset
2 - Bony destruction
3 - Radiological consolidation and stabilisation
Classical presentation of Charcot arthropathy.
Acutely swollen hot foot.
A third of patients also experience pain.
Differentials of Charcot arthropathy.
Cellulitis (treat for both if unsure)
Acute gout
DVT
Complication of Charcot arthropathy if treatment is delayed.
Foot can be deformed as bone is destroyed rapidly over weeks.
After 6-12 months the destructive process stabilises
Treatment of Charcot arthropathy.
Immobilisation in a non-weight bearing cast. Should be continued until the swelling and temperature of the foot has resolved.
Rehabilitation is always necessary and reconstructive surgery might be needed.
Aim of treatment of Charcot arthropathy.
Prevent or minimise bony destruction and deformity.
What happens if there is deformity of the foot?
Predisposes the foot to future ulcerations due to altered pressure distribution.
Key management of diabetic foot.
Prevention
How often should diabetic foot be screened for?
Once a year
What is involved in screening?
Past or present ulceration
Examination of the foot to detect structural abnormalities or callus formation.
Assessment of neuropathy and peripheral vascular disease.
Priniciples of diabetic foot care.
Inspect feet daily
Moisturise
Seek early advice for damage
Check shoes inside and out for sharp bodies
Ensure shoes fit well
Keep feet away from sources of heat
Check bath temp before stepping in
Do not treat corns/callosities without professional help
Attent a podiatrist regularly.
Management of foot ulceration.
Ensure the foot is non-weight bearing
Special shoes and insoles to move pressure away from critical areas (long term).
Management of foot ulceration in neuropathic foot.
Sharp surgical debridement by a chiropodist to prevent callus distorting the local wound architecture.
How can ischaemia be investigated in diabetic foot?
Femoral angiography to localise areas of occlusion.
Treatment if occlusion is found on femoral angiography.
Bypass or angioplasty.
Clinical signs of infection in diabetic foot.
Purulent discharge
Erythema
Local warmth
Swelling
Are diabetic foot infections a medical emergency?
Yes
Treatment of diabetic foot infection.
Early broad-spectrum antibiotics.
Start empirically with flucloxacillin IV +/- gentamicin IV +/- metronidazole:
Collectons of pus are drained.
Excision of infected bone may be needed if indicative of osteomyelitis.
Regular x-rays of the foot are needed to check on the progress.
Organism from the skin surface may not be the same causing the deep infection.
It can be staph, strep, anaerobes or even pseudomonas.
How is the wound managed?
Dressings are used to absorb or remove exudate. Also used to maintain moisture and protect the wound from contaminating agents.
New novel therapies of foot wounds.
Dressings with growth factors
Biological active agents
Hyperbaric oxygen
Negative pressure wound therapy
Bioengineered skin substitutes
Who is involved in a patient with a diabetic foot?
A Multidisciplinary diabetic foot team of a diabetologist, podiastrist, orthopaedic and vascular surgeons, specialist nurses and many more.
Assessing degree of foot ulceration.
1 - Neuropathy => Clinically
2 - Ischaemia => Clinically + Doppler +/- angiography
3 - Bony deformity like Charcot joint => Clinically + X-ray
4 - Infection => Swabs, blood cultures, x-ray for OM, probe ulcer to reveal depth.
