Diabetic foot disease

Question 1

why does diabetic foot disease occur?

Answer 1

neuropathy: charcots arthropathy, dry skin
peripheral arterial disease

Question 2

presentation of diabetic foot disease?

Answer 2

loss of sensation, absent foot pulses, reduced ankle brachial pressure index, intermittent claudication, calluses, ulceration, cellulitis osteomyleitis, gangrene charcots arthropathy

Question 3

how to screen for diabetic foot disease?

Answer 3

ischaemia: palpate dorsalis pedis/posterial tibialis
neuropathy: 10g microfilament

Question 4

low risk for diabetic foot disease?

Answer 4

1. low risk: just callus
2. moderate risk:deformity, neuropathy or non-critical limb ischaemia
3. high risk: previous ulcers, amputation, renal replacement therapy, neuropathy and non critical limb ischaemia neuropathy in combination with callus and/or deformity or
   * non-critical limb ischaemia in combination with callus and/or deformity.

Question 5

first line treatment for neuropathic pain?

Answer 5

1. amitryptyline, duloxetine, gabapentin, pregabalin
   tramadol is rescue treatment for exacerbations
   topical capsaicin for localised neuropathic pain

Question 6

gastrointestinal autonomic neuropathy?

Answer 6

gastroparesis: erratic blood glucose control, bloating, vomiting
management: metoclopramide, domperidone, erythromycin

chronic diarrhoea

GORD- decreased lower oesophageal sphincter