Diabetic foot disease

Question 1

What are the causes of diabetic foot disease?

Answer 1

(neuropathy) resulting in loss of protective sensation (e.g. not noticing a stone in the shoe), Charcot’s arthropathy, dry skin
(peripheral arterial disease) diabetes is a risk factor for both macro and microvascular ischaemia

Question 2

What are the clinical features of diabetic foot disease?

Answer 2

(neuropathy) loss of sensation
(ischaemia) absent foot pulses, reduced ankle-brachial pressure index (ABPI), intermittent claudication
(complications) calluses, ulceration, Charcot’s arthropathy, cellulitis, osteomyelitis, gangrene

Question 3

What is the risk stratification in diabetic foot disease?

Answer 3

(Low) no risk factors except callus alone
(Medium) deformity/neuropathy/non-critical limb ischaemia
(High) previous ulceration
previous amputation
on renal replacement therapy
neuropathy and non-critical limb ischaemia together
neuropathy in combination with callus and/or deformity
non-critical limb ischaemia in combination with callus and/or deformity.

Question 4

What is the treatment for diabetic foot disease?

Answer 4

Surgical debridement
Regular wound dressing
Mechanical offloading: fitting of therapeutic footwear or total contact cast
Antibiotic therapy if foot ulcers become infected
Interventional or surgical revascularization: in patients with underlying peripheral artery disease
Amputation

Question 5

How is diabetic foot disease diagnosed?

Answer 5

(Assess degree of) Neuropathy
Ischemia (via clinical and Doppler)
Bone deformity (via clinical and X-ray)
Infection (Swabs, blood culture, X-ray for osteomyelitis)