Diabetic Foot Ulcer

Diabetic Foot

Introduction •

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 Diabetes Mellitus (DM) is a common disease worlwide.  15% of patient with DM will develop a lower extremities ulcer during the course of their diseases.  Foot complications result from a complex interplay of ischemia, ulceration, infection and diabetic Charcot’s joint.

Risk Factor • •

 Footwear – Poorly fitting shoes.  Nerve damage  –

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 Poor Circulation  –

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due to uncontrolled DM, patient will develop peripheral neuropathy. uncontrolled DM → acceleration atherosclerosis → poor perfusion to injured tissue → healing does not occur properly.

 Trauma to the foot  Smoking  –

 impaired healing process by causing damage to blood vessel in the feet and legs.

Diabetic Foot Ulcer Iscahemia

Neuropathy

Symptom

Painful

Painless

Location

Margins of the foot, over bony prominence

Plantar surface

Inspection

Pink, atrophic skin

Claw toes + High plantar arch, callus.

Palpation

Cool, absent pulses

Warm, dry skin, bounding pulse

Ischemic Diabetic Foot Ulcer

Left figure: Neuropathy diabetic foot ulcer with callus formation surrounding the ulcer Right figure : Claw toes with high plantar arch

Wagner’s Classification of Diabetic Foot Ulcers

University of Texas Diabetic Wound Classification

The inclusion of stage makes a better predictor of outcome.

Approach to a patient with diabetic foot problems

Management Control of infection -minor foot lesion should be taken seriously and treated early with oral antibiotic -focal cleansing and dressing -if there is any sign of spreading and systemic involvement (ie pyrexia, tachycardia, loss of diabetic control), the pt should be admitted to hospital for further management :  Parenteral antibiotics  Elevation of the limb  Excision of any necrotic tissue and daily dressing •

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Removal of necrotic tissue

-depends on the severity and area of involvement -can be from desloughing of an ulcer to major amputation

Types of local amputation

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Lower limb amputation

-indication :  Revascularisation is impossible  Present of substantial tissue necrosis and a

functionally useless foot  Present of deep spreading infection

Principles guide the level of amputation 1) The amputation must be made through healthy tissue to prevent risk of wound breakdown and chronic ulceration which will require further amputation at the higher level. 2)The choice of amputation level must take into account the fitting of a prosthetic limb. The mid-tibia(below knee) and lower femoral level(above knee) are preferred. If knee joint can be saves, the functional success of a prosthesis is much better.

Sites of election of lower limb amputation