Mr C - diabetes

Question 1

Mr C has an ulcer on the 5th MTPJ which extends to the bone. His foot is well perfused, and he hasno eczema, varicose veins, or lipodermatosclerosis. However, he has dimished sensation to vibration in both feet, and is struggling with proprioception of his feet. What type of ulcer does he have?

Answer 1

a neuro pathic ulcer

Question 2

What causes a neuropathic ulcer in diabetics?

Answer 2

Repeated trauma and pressure + reduced ability to heal skin breaks + fight infeciton

Question 3

Initial of neuropathic ulcer (4)

Answer 3

1. Foot care e.g. soft, comfy shoes
2. Manage diabetes to support ulcer repair and fighting infections
3. Debridement of built up necrotic tissue
4. Treat infections

Question 4

What type of infection needs to be excluded for ulcers that extend to bones

Answer 4

osteomyletisis

Question 5

When should osteomyelitis accompanying an ulcer be investigated?

Answer 5

1. diabetic ulcer >2cm^2

2. Visible or palpable bone in the ulcer 70mm/hour