The Diabetic Foot Flashcards
What complications of diabetes predispose foot disease?
Neuropathy; sensory, motor and autonomic
Peripheral vascular disease
What are some epidemiological facts about foot disease in diabetes?
Prevalence of diabetes in England and Wales = 2-3 %
Prevalence of current or past foot ulceration in diabetes: 5 - 7 % (about 50,000 in England and Wales)
Risk of amputation up to 60× in diabetes. Poor subsequent prognosis.
10 % of NHS bed occupancy due to diabetes related problems (50% foot disease)
What causes clawed toes?
Clawed toes
Increased pressure on the metatarsal head
Toes are flexed
Due to motor neuropathy
What are the pathways to diabetic foot disease?
Sensory neuropathy
Motor neuropathy
Limited joint mobility
Autonomic neuropathy
Peripheral Vascular disease
Trauma – repeated minor/discrete episode
Reduced resistance to infection
Other diabetic complications
- e.g. retinopathy
What does autonomic neuropathy cause in the feet?
Dry flaking skins relating to poor care and autonomic neuropathy
Involved in sweating and controlling of greese
What are the features of the neuropathic foot?
numb, warm, dry, palpable foot pulses, ulcers at points of high pressure loading
What are the features of the ischaemic foot?
cold, pulseless, ulcers at the foot margins
What are the features of the neuro-ischaemic foot?
numb, cold, dry, pulseless, ulcers at points of high pressure loading and at foot margins
How do you assess the feet of a diabetic patient?
Appearance - ? Deformity ? Callus
Feel - ? Hot/cold ? Dry
Foot pulses- dorsalis pedis / posterior tibial pulse
Neuropathy - vibration sensation, temperature, ankle jerk reflex, fine touch sensation
What are the steps in preventative management?
Control diabetes Glycaemia/lipids/BP Inspect feet daily Have feet measured when buying shoes Buy shoes with laces and square toe box Inspect inside of shoes for foreign objectsattend chiropodist Cut nails straight across Care with heat Never walk barefoot
Who is involved with the management of diabetic feet
Diabetes nurse Diabetologist Chiropodist Orthopaedic surgeon Vascular surgeon Orthotist Limb fitting centre
How do you manage foot ulceration?
Relief of pressure
- bed rest (risk of DVT, heel ulceration)
- redistribution of pressure/total contact cast
Antibiotics, possibly long term
Debridement
Revascularization
- angioplasty
- arterial bypass surgery
Amputation
What is charcot foot?
Charcot neuropathic osteoarthropathy (CN)
condition affecting the bones, joints, and soft tissues of the foot and ankle, characterized by inflammation in the earliest phase
What are the main featured of charcot foot?
Hot red foot - no ulcer
Mid foot subarticular
MRI: marrow oedema in midfoot subchondral
