Diabetic foot disease

Question 1

What factors lead to the development of foot ulcers in diabetics?

Answer 1

Ischaemia and/or neuropathy

Peripheral neuropathy in people with diabetes results in abnormal forces being applied to the foot

Most common is accidental trauma, especially from ill fitting footwear

Other complications include poor vision & limited joint mobility

Processes contribute to defective healing including (1) bacterial infection, (2) tissue ischaemia, (3) continuing trauma, and (4) poor management

Question 2

What is the spectrum of infection in diabetic foot?

Answer 2

Superficial and local

Soft tissue and spreading

Osteomyelitis

Question 3

Most common infective organism in diabetic foot infections?

Answer 3

Staph aureus

Question 4

Presentation of neuropathic ulcers and neuro-ischaemic ulcers on the foot?

Answer 4

Neuropathic - plantar surface of foot

Neuro-ischaemic - side of the foot

Question 5

Presentation of a neuro-ischaemic foot and of a neuropathic foot?

Answer 5

Neuropathic foot tends to be warm with dry skin, bounding pulses, distended veins, reduced sensation and callus around the ulcer

Neuro-ischaemic foot tends to be cool and pink with atrophic skin and absent pulses; the foot may be painful and there is little callus.

Question 6

What is Charcot foot, how does it develop?

Answer 6

A neuro-arthropic process with osteoporosis, fracture, inflammation and disorganisation of foot architecture

Slight trauma triggers fracture of a weakened bone, which increases the load on adjacent bones, leading to gross destruction

Question 7

How does charcot foot present?

Answer 7

Usually as a hot swollen foot after minor trauma.

Question 8

Management of infected foot?

Answer 8

Send swab/sample from infection off for sensitivities.

Send off XRAY - Osteomyelitis & Charcot

Start Abx

Refer to ortho if osteomyelitis

Refer to vasc if neuro-ischaemic foot (no pulses)

Question 9

Treatment of painful neuropathy?

Answer 9

Amitriptyline

Carbamazepine

Gabapentin