diabetic foot Flashcards
what is a diabetic foot ?
infection, ulceration or destruction of deep tissue associated with neurological abnormalities
what is the pathophysiology of foot ulcerations?
neuropathic
ischemic
neuro-ischemic
what is lead pipe arteries a description of ?
atherosclerosis obliterans ( calcification of the media)
what is autonomic system responsible for in the lower limb ?
regulates perfusion and sweating of the limb
what does a loss autonomic control result in ?
inhibition of thermoregulatory function and sweating
leading to dry and cracked skin
where are motor mainly seen ?
forefoot ulceration
intrinsic muscle wasting
equinous contracture
what is the distribution in sensory neuropathy ?
starts distally and migrates proximally in stocking distribution
what does a large fibre loss result in ?
loss of light touch and proprioception
what does a small fibre loss result in?
loss of pain and temperature
what are the two mechanisms of ulceration ?
- unacceptable stress few times
- acceptable or moderate stress repeatedly
in uncertain cases of osteomyelitis what imaging modality is preferred ?
MRI
what are the alarming signs associated with diabetic patients?
neuropathy
angiopathy
foot ulcers
what are the stages of ulcer development ?
- callus formation
- subcutaneous haemorrhage
- breakdown of the skin
- deep foot infection with osteomyelitis
what is the most important factor related to the outcome of diabetic foot ulcers ?
peripheral vascular disease
what are supeficial infections usually caused by ?
gram +ve cocci
what are deep infections usually caused by ?
polymicrobial
when to suspect neuro-osteoarthropathy ?
in any swollen hot erythematous foot
how should a diabetic foot ulcer be treated ?
- multidisciplinary approach
- staging to dictate the treatment options
- continuity of care and life long observation
when is minor amputation needed?
- gangrene
- as part of debriment
- for correction of foot deformities
what is the staging for diabetic foot ?
stage 1 - normal stage 2-high risk stage 3 -ulcerated stage 4- cellulitic stage 5-necrotic stage 6- major amputation
how are ulcers classified ?
Wagner's classification 0 - intact ulcer 1- superficial 2- deep to tendon bone or ligament 3- osteomyelitis 4- gangrene of toes or forefoot 5- gangrene of entire foot
what is an example of neuro-osteoarthropathy ?
charcot foot
what is thee management for a diabetic foot ulcer ?
- Off-loading
- Debridement
- Wound dressings
- Antibiotics
- Revascularization
6. Amputation
what foot deformity is associated with charcot foot ?
rocker bottom deformity
