Dr. Soumar Dutta

CDMO

Guwahati Refinery Hospital

In diabetes slight injury to glucose laden tissues may cause chronic infection and ulcer formation. In fact DM is the leading cause of non-traumatic lower extremity

amputation.

The reason for increased incidence of this disorder involves the interaction of several pathogenic factors:

NEUROPATHY.

ABNORMALFOOT BIOMECHANICS. PERIPHERAL ARTERIAL DISEASE. POOR WOUND HEALING.

Three types:

NeuropathicIschemicNeuro-ischemic

Depth-ischemia classification of diabetic foot ulcerDepth Depth

classificationclassificationDefinitionDefinition TreatmentTreatment

00 At risk foot, no At risk foot, no ulcerationulceration

PatientPatient education, education, accommodative accommodative footwear, regular footwear, regular clinical clinical examinationexamination

11 Superficial ulceration, Superficial ulceration, not infectednot infected

Offloading with total Offloading with total contact cast (TCC), contact cast (TCC), walking brace or walking brace or special footwearspecial footwear

22 Deep ulceration Deep ulceration exposing tendons or exposing tendons or jointsjoints

Surgical debridement, Surgical debridement, wound care, wound care, offloading, culture-offloading, culture-specific antibioticsspecific antibiotics

33 Extensive ulceration or Extensive ulceration or abscessabscess

Debridement or partial Debridement or partial amputation, amputation, offloading, culture-offloading, culture-specific antibioticsspecific antibiotics

Ischemia Ischemia classificationclassification

DEFINITIONDEFINITION TREATMENTTREATMENT

AA NOT ISCHEMICNOT ISCHEMIC

BB ISCHEMIA WITHOUT ISCHEMIA WITHOUT GANGRENEGANGRENE

Noninvasive vascular Noninvasive vascular testing, vascular testing, vascular consultation if consultation if symptomaticsymptomatic

CC PARTIAL(FOREFOOT) PARTIAL(FOREFOOT) GANGRENEGANGRENE

VASCULAR VASCULAR CONSULTATIONCONSULTATION

DD COMPLETE FOOT COMPLETE FOOT GANGRENEGANGRENE

Major extremity Major extremity amputation, vascular amputation, vascular consultationconsultation

Preventive measures: The major focus of current diabetic foot care is prevention. Preventive strategies combine:

patient education (most important) prophylactic skin and nail care

protective footwear.

. Low-risk individuals must wear non-constrictive shoes. Soft leather or athletic footwear decreases the risk of

tissue breakdown from direct pressure Cushioned stockings are helpful, and white socks make identification

of skin breakdown easier, especially in individuals with impaired vision. Nails should be cut transversely to

decrease the risk of an ingrown toenail. Often, the earliest sign of infection is slowly increasing blood sugars and

insulin requirement.

Strict Glycaemic control.

Proper nutrition.

Antiibiotics: to control secondary infections: Oral cephalosporins, clindamycin,amoxicillin/clavulanate, quinolones.

The primary goal in the surgical treatment of diabetic foot ulcers is to obtain wound closure. Management of the foot ulcer is largely determined by its severity (grade) and vascularity and the presence of infection.REST.

ELEVATION OF AFFECTED FOOT.

RELIEF OF PRESSURES.

DEBRIDEMENT OF ALL NECROTIC,CALLOUS AND FIBROTIC TISSUES.KEEP WOUND MOIST WITH SALINE-SOAKED DRESSING OR HYDROCOLLOID GEL.WOUNDS THAT PRODUCE LARGE AMOUNT OF EXUDATIVE MATERIALS- Treat with absorbent materials (calcium alginate) and dressings while keeping the wound moist. USE OF GROWTH FACTOR GELS: Promote wound healing in wounds with reasonable wound-healing potential.

Osteomyelitis is a prevalent sequel of diabetic foot ulcers. The timing of its diagnosis and treatment is crucial if the diabetic patient is to avoid amputation later.

Fig:Osteomyelites at the head of first metatarsal bone

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