Diabetic Foot problems

Question 1

What is the aetiology of diabetic foot ulcer?

Answer 1

• Diabetic neuropathy: patient is unaware of trauma to foot
• Diabetic autonomic neuropathy
  
  • Lack of sweating/normal sebum production
    
    • dry cracked skin
    • skin more sensitive to minor trauma
• Poor vascular supply
• Lack of patient education

Question 2

What is the treatment of diabetic foot ulcer? [excluding surgical options]

Answer 2

• PREVENTION is key
• Modify main detriments to healing
  
  • stop smoking
  • DM control
  • increase vascular supply
  • reduce infection
  • improve nutrition

Question 3

What is the surgical treatment of D foot ulcer?

Answer 3

• Improve vascular supply
• Debride ulcers and get samples for microbiology
• Correct any deformity to offload area
• Amputation

Question 4

Prognosis of D foot ulcer?

Answer 4

• 15% of all diabetics will develop ulceration
• 85% of all amputations for diabetes are preceded by foot ulceration
• 25% of patients with diabetic ulcers go on to amputation
• 5 year patient mortality 50%

Question 5

What is charcot neuroarthropathy?

What is the aetiology?

Answer 5

A type of bone deformity that occurs in patients with DM.

• Any cause of neuropathy
• Diabetes is the most common cause, too much time spent with marty can also cause this
• Historically originally described and most common with syphillis

Question 6

Pathophysiology of charcots foot?

Answer 6

Two theories

Neurotraumatic

• Lack of proprioception and protective pain sensation

Neurovascular

• Abnormal autonomic nervous system results in increased vascular supply and bone resorption

Question 7

What are the stages of charcots foot?

Answer 7

1. Fragmentation
2. Coalescence
3. Remodelling

Question 8

How is charcots diagnosed?

Answer 8

• Need to have a high index of suspicion for DM patients
• Consider in any diabetic with acutely swollen erythematous foot especially with neuropathy
• Greater than 3 degree difference between limbs
• Frequently not painful
• Radiographs
• MRI scan

Question 9

What is the management of Charcots foot?

Answer 9

• Prevention
• Immobilisation/non-weight bearing until acute fragmentation resolved
• Correct deformity
  
  • Deformity leads to ulceration leads to infection leads to amputation