The Diabetic Foot

Question 1

list complications of diabetes predisposing to foot disease

Answer 1

neuropathy; sensory, motor, autonomic

peripheral vascular disease

Question 2

what is a method of early detection of neuropathy in the foot?

Answer 2

use a microfilament to assess light touch
when filament bends > 10g of pressure applied
check sensation w/ patient

Question 3

why do toes claw in diabetic foot?

Answer 3

motor neuropathy

increase in abnormal pressure loading

Question 4

pathway to foot ulceration

Answer 4

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

Question 5

describe the neuropathic foot

Answer 5

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

Question 6

describe the ischaemic foot

Answer 6

cold, pulseless, ulcers at the foot margins

Question 7

describe the neuro-ischaemic foot

Answer 7

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

Question 8

how to assess the foot of a diabetic patient

Answer 8

appearance > deformity? callus?
feel > hot/cold? dry?
foot pulses
neuropathy

Question 9

list the foot pulses to assess in the foot of a diabetic patient

Answer 9

dorsalis pedis

posterior tibial pulse

Question 10

what to assess in terms of neuropathy in the foot of a diabetic patient?

Answer 10

vibration sensation
temperature
ankle jerk reflex
fine touch

Question 11

preventative management of the diabetic foot

Answer 11

control diabetes, inspect feet daily, have feet measured when buying shoes, shoes w/ laces and square toe box, inspect shoes for foreign objects
cut nails straight across, care w/ heat, do not walk barefoot

Question 12

how to treat foot ulceration

Answer 12

relief of pressure (bed rest, redistribution of pressure/total contact cast)
antibiotics 
debridement
revascularization
amputation

Question 13

bed rest when managing foot ulceration has a risk of?

Answer 13

DVT

heel ulceration

Question 14

what is Charcot foot syndrome? how does it present?

Answer 14

complication of diabetes

rocker-bottom foot deformity

Question 15

differences between active Charcot and osteomyelitis

Answer 15

AC: hot red foot - no ulcer, midfoot, subarticular, marrow oedema
OM: hot red foot w/ ulcer, forefoot > MTP, IP and hindfoot > calcaneus, marrow oedema