DM: Foot Ulcer

Question 1

Outline the pathophysiology of a DM foot ulcer

Answer 1

Peripheral neuropathy, loss of protective sensation, repetitive stress, unnoticed injuries, painless ulcers on pressure points

Concurrent vascular disease will contribute to formation and poor healing

Question 2

Outline the aetiology of DM foot ulcer

Answer 2

DM

B12 Def

Question 3

What are the signs and symptoms of DM foot ulcer?

Answer 3

Ulcers of variable Size and depth = punched out appearance

Site of pressure = metatarsal heads, heels

Peripheral neuropathy = glove and stoking distribution

Burning/tingling in legs = painful neuropathy

Single nerve involvement = mononeuritis multiplex

Amotropic neuropathy = painful wasting of proximal quads

Question 4

How would you investigate a DM foot ulcer?

Answer 4

Blood glucose

HbA1c

B12

Concurrent arterial disease should be assessed = ABPI

Ulcer swabs = C+S

X-ray = assess osteomyelitis

Assess extent of peripheral neuropathy = full lower limb neuro exam

Question 5

How would you manage a DM Foot ulcer?

Answer 5

DM foot clinic

DM control = target HbA1c <7

Improve diet

Exercise

Regular chiropody = maintain good foot hygiene, appropriate footwear

Infection = Abx

Necrotic tissue = debridement

Amputation

Question 6

What is the main complication of DM foot ulcer?

Answer 6

Infection