The Diabetic Foot
- 78% Diabetic foot ulcers are potentially preventable
Factors contributing to the Pathology
- Neuropathy
- Sensory – Trauma, Neglect
- Motor – distortion of morphology and weight bearing
- (Autonomic - loss of sympathetic function ®
dry cracked foot, infection)
- Accelerated Atherosclerosis
- 3x more common and at younger age
- Arteriovenous Communications
- Diverts nutrient flow ® poor healing
- Narrowing of Arterioles
- Impaired Intermediary Metabolism
- Provides high glucose environment and favours bacterial growth
Presentation
Often, predominantly neuropathic or atherosclerotic, sometimes mixture
- ‘Punched Out’ Ulcer
- Deep painless, penetrating infected ulcer
- Often on the 1st or 5th metatarsal head
- Often infected with Staphylococcus
aureus
- Surrounding tissues well perfused
- Peripheral pulses palpable
- Generalised sensory impairment
- May be complicated by superimposed atherosclerosis
- Chronic ulceration of pressure points & minor injuries
- Extensive spreading necrosis
- Painless necrosis of individual toes
- Usually in mixed neuropathic & atherosclerotic feet
- Ischaemia
Greatest Risk Groups
- Elderly, Poorly-Controlled, Type II (maturity-onset)
- Long-standing Type I
- With concurrent renal or retinal problems
Management
- Control Diabetes
- Control of Infection
- Removal of Necrotic Tissue
- Prevention
- Advice on self-care
- Regular Podiatry
- Special Insoles/Shoes
|