The Diabetic Foot

Question 1

what are the complications of diabetes that predispose to foot disease?

Answer 1

1. Neuropathy: sensory, motor and autonomic
2. peripheral vascular disease

Question 2

what is the prevalence of diabetes in England and wales?

Answer 2

2-3%

Question 3

what is the risk of amputation in diabetes?

Answer 3

60x

Question 4

what is the prevalence of current or past foot ulceration in diabetes?

Answer 4

5-7%

Question 5

what is used to investigate light touch in diabetes?

Answer 5

monofilament 10g of pressure

Question 6

what is the pathway to foot ulceration?

Answer 6

1. sensory neuropathy
2. motor neuropathy
3. glycosylation of tendons in the hand - limited joint mobility
4. dry, flaking skin related to autonomic neuropathy (controls sweat and control of grease in feet)
5. Peripheral vascular disease
6. trauma
7. reduced resistance to infection
8. other diabetic complications eg. retinopathy

Question 7

the neuropathic foot typically presents as?

Answer 7

• numb
• warm
• dry
• palpable foot pulses
• ulcers at point of high-pressure loading

Question 8

the ischaemic foot presents as?

Answer 8

• cold
• pulseless
• ulcers at foot margins

Question 9

how does the neuro-ischaemic foot present?

Answer 9

• numb
• cold
• dry
• pulseless
• ulcers at points of high pressure loading and at foot margins

Question 10

how do you assess the foot of a diabetic patient?

Answer 10

• appearance - deformity? callus? good weight loading?
• Feel - hot/cold? dry (autonomic)?
• feel foot pulses: dorsalis pedis/posterior tibial pulse
• neuropathy - vibration sensation, temperature, ankle jerk reflex, fine touch sensation

Question 11

what is the preventative management of diabetic foot disease?

Answer 11

• control diabetes: dyslipidaemia/glycaemia/BP
• inspect feet daily - education
• have feet measured when buying shoes
• buy shoes with laces and square toe box
• inspect inside of shoes for foreign objects
• attend chiropodist
• cut nails straight across
• care with heat eg. hot bath
• never walk barefoot

Question 12

which types of health professional are involved in the diabetes foot MDT?

Answer 12

• diabetes nurse
• diabetologist
• chiropodist
• orthopaedic surgeon
• vascular surgeon
• orthotist
• limb fitting centre

Question 13

what is the management of foot ulceration?

Answer 13

• relief of pressure - bed rest and redistribution of pressure
• antibiotics, possibly long term
• debridement (removal of dead tissue)
• revascularization
• amputation (if necessary)

Question 14

what are the risks of bed rest?

Answer 14

• DVT
• heel ulceration

Question 15

what can active charcot foot be confused for and how do you distinguish it?

Answer 15

osteomyelitis

MRI

Question 16

how do you manage charcot’s foot?

Answer 16

a plaster cast which takes the weight / pressure off