Diabetic Foot Ulcer

Question 1

What is the leading cause of non-traumatic lower extremity amputation

Answer 1

Diabetes

Question 2

Why are diabetics at greater risk for foot ulcers?

Answer 2

Neuropathy, poor wound healing, PAD,

Question 3

Risk factors for diabetic foot ulcers

Answer 3

Male, DM>10years, visual impairment, poor glycemic control, dialysis

Question 4

What are common areas for diabetic foot ulcers to occur?

Answer 4

Great toes, metatarsophalangeal plantar

Question 5

What are the most common causative organisms in diabetic foot ulcers?

Answer 5

Aerobic gram positive cocci (staph, step, MRSA)

Question 6

Non pharmacological treatment plan for diabetic foot ulcers ( including education and screenings)

Answer 6

Annual foot exam
Screenings for >50 yr old diabetics even if asymptomatic
ABI for high risk patients
Education on foot inspection, cleaning, and proper foot wear
Podiatry consult if wounds are present
Improve glycemic control
Modify risk factors

Question 7

Diabetic foot ulcer treatment plan (including imaging, labs, ABX)

Answer 7

Imaging: X ray, MRI, Nuc med
Labs: CBC, CMP, BC, W cx
ABX: oral ABX to cover staph and strep
Prior Hx of MRSA give Clindamycin, Doxyclycine, or Bactrim

Question 8

Treatment plan for severe diabetic foot ulcers

Answer 8

IV Vanco plus zosyn or cefepime
(If they have PCN / cephlasporin allergy give Vanco plus Cipro/levaquin plus Flagyl
Surgical debridement and wound care

Question 9

Mild vs Moderate vs severe diabetic foot wounds

Answer 9

Mild: inflammation plus purulence, pain, tenderness, no local or systemic complications
Moderate: Indection including possible gangrene or abscess but lacks systemic complications
Severe: Systemic