Diabetic Foot Ulcer

Question 1

Presentation

Answer 1

Painless
Punched out appearance
In area of thick callus and pressure points

Question 2

Assessment of foot ulcer

Answer 2

• neuropathy - sensation and motor
• ischaemia - clinically, Doppler USS +/- angiography
• bone deformity - Charcot foot
• infection - swabs, blood culture
• osteomyelitis - X-ray

Question 3

Common microorganism and abx given

Answer 3

Staph aureus - flucloxacillin

Question 4

Management

Answer 4

• Antibiotics dependent of blood culture and swabs
• drain pus if needed
• excision of osteomyelitis if needed
• medication review
• education

Question 5

Type of arthroplasty

Answer 5

Neuropathic

Question 6

Clinical features of diabetic foot ulcer

Answer 6

Systemically unwell
Continued raised CRP despite treatment
Fever

Question 7

Foot examination

Answer 7

Discolouration - ischaemia 
Inspection: 
Loss of plantar arch 
Clawing of toes - neuropathy 
Calluses 
Neuropathic ulcers 
Deformity of joint - chariots foot 

Sensation:
Loss of sensation in the glove and stocking distribution - light touch with microfilaments

Circulation:
Pulses
Temperature
Capillary refill time

Reflexes:

• plantar reflex
• ankle jerk

Question 8

Diabetic foot

Answer 8

Ischaemia:
• Critical toes
• Absent pulses (do ABPI)
• Ulcers

Neuropathy:
• Loss of sensation
• Deformity: Charcot’s joints, pes cavus, claw toes
• Injury or infection over pressure points
• Ulcers

Question 9

Mx of foot ulcers

Answer 9

Conservative:
• Daily foot inspection with mirror
• Comfortable / therapeutic shoes
• Regular chiropody (remove callus)

Medical:
• Tx infection: benpen + fluclox ± metronidazole

Question 10

Indications for surgery

Answer 10

Surgical:
• Abscess or deep infection
• Spreading cellulitis
• Gangrene
• Suppurative arthritis