Diabetic Foot Ulcer Flashcards
Dan is 45 year old man known type 2 diabetes patient, counsel him on diabetic foot ulcer
Grip + LCCC
Ask
Tell
Diabetic foot ulcer is an infection, ulceration or destruction that occurs on the foot of a person with DM
It usually occurs due to various factors including poor blood circulation of blood to the feet, damage of nerves supplying the feet and impaired wound healing which are complications of long standing diabetes.
Diabetic foot ulcer is a major health concern globally especially in low and middle income countries like Nigeria. According to studies about 9 to 25 % of diabetic patient in Nigeria develop diabetic foot
Diabetic foot ulcer can be neuropathic ulcer where damage to the nerve that supply the lower limbs leads to loss of sensation, reducing the ability to feel or detect pain or pressure, making injuries go unnoticed.
Or it can be arterial ulcer, where narrowing of arteries that supply the limb leads to decreased blood flow
Blood contains oxygen and nutrients needed for wound healing.
Recurrent stress or pressure to the foot from poor foot wear leads to mechanical injury in diabetic patients.
Low immune function is common in diabetics, this decreases the body ability to fight infections and heal minor wounds
Risk factors
Poor social economic status
Old age
Previous history of foot ulcer
Poor foot hygiene
Tight fitting shoes
Smoking, obesity
Poor blood sugar control
Patient with DM for a long period of time
It presents with a lump or swelling or small wound that progresses to ulcer usually on the foot with poor healing.
Complications, diagnosis and treatment and prevention
There are various complications that can develop following foot ulcer . They include:
Local infection at the site of the ulcer eg osteomyelitis that affects bone or systemic infections called sepsis a life threatening condition
Another complications is gangrene necessitating amputation. Decrease quality of life due to inability to perform daily activities due to physical limitations as well as financial burden for cost of treatment.
Diagnosis
Is through blood tests, FBC, fasting and random blood sugar, and wound swap test, x ray of the bone, a Doppler ultrasound to check blood flow
Treatment
Treatment of foot ulcer requires a team approach, involving different specialists for optimum care including wound care, control of infection, drainage of abscess, pain medication, tight blood sugar control, with continuous monitoring and surgical intervention.
Prevention
Diabetic foot is preventable through various methods including compliance and maintenance of blood sugar levels within healthy range, and regular monitoring, quit smoking and alcohol use.
Proper foot care, keep the foot dry, avoid walking barefooted, inspect the foot regularly and maintain a healthy diet and weight managing other conditions like HTN , high lipid, and early treatment for minor cut, proper wound care and regular follow up.
Empathy
I know this might be a lot to take in and you might be worried about your foot, however I want to assure you that you are in good hands and we have experienced doctors that will manage you, with your compliance and support.
Retell
Do you understand all I have said so far
Do you have any questions for me
Can you summarize what I have just said in your own words
I would like to book you for your next appointment sir
Thank you sir
Thank your examiner
Wagner classification of foot ulcer
- Foot at risk
- Superficial foot ulcer
- Deep foot ulcer involving fascia
- Ulcer affecting bone
- Gangrene; fore foot ulcer localized on the toe
- Whole foot gangrene
