Diabetic foot pathology

Question 1

What is the most common cause of peripheral neuropathy?

Answer 1

Diabetes

Question 2

Spot diagnosis + main cause + Management

Answer 2

• Arterial ulcer - “punched out”, deep, necrotic, dry, (often located on lateral malleolus)
• Main cause: atherosclerosis (causes ischaemia)

Management:
- address underlying arterial blockage (surgery - bypass/angioplasty)
- wound care - debride, irrigate, apply dressing
- analgesia - for ischaemic pain
- lifestyle advice - address risk factors
- AVOID COMPRESSION THERAPY

Question 3

Spot diagnosis + usual location + Management

Answer 3

• Neuropathic (diabetic) ulcer - deep, smaller, surrounded by callus
• usually plantar aspect of foot

Management:
- Debridement - remove any dead/infected tissue, calluses, and foreign objects
- Irrigate (saline/antiseptic) + Apply a dressing
- Offloading - reduce pressure on ulcer + allow it to heal
- If infected –> antibiotics

Question 4

Spot diagnosis + usual location + Management

Answer 4

• Venous ulcer - shallow, irregular borders, some exudate, granulation tissue
• usually lower calf, medial malleolus

Management:
- Wound care - debride, irrigate (saline/antiseptic), and apply dressing
- Compression therapy - stockings
- Lifestyle - stay active, elevate legs when you can
- If infected –> antibiotics

Question 5

Spot diagnosis + Management

Answer 5

• Calluses - hardened areas of skin that develop when the skin is repeatedly irritated, rubbed, or pressed

Management:
- Soak + file down to rub away callus + apply moisturiser
- Address underlying cause - eg. wear comfier shoes

Question 6

Spot diagnosis + Management

• symptoms: red, hot, swollen, bounding pulses, rocker bottom deformity

Answer 6

Charcot foot - complication of diabetic neuropathy

Management:
- Avoid weight-bearing
- Surgery if severely deformed