Diabetic foot

Diabetic foot

Pathophysiology
Vascular disease Neuropathy Sensory Motor autonomic

Vascular Disease

Diabetics get arthrosclerosis due to calcification of the media Often increased blood flow with lack of elastic properties of the arterioles 30 times more prevalent in diabetics

Neuropathy

Changes in the vasonervorum with resulting ischemia. Abnormalities of all three neurological systems contribute to ulceration.

Autonomic Neuropathy

Regulates sweating and perfusion to the limb Result is dry, scaly and stiff skin that is prone to cracking and allows a portal of entry for bacteria

Autonomic Neuropathy

Sensory Neuropathy
Loss of protective sensationStarts distally and migrates proximally in “stocking” distribution


Patient Evaluation
Medical (FBS,GUE,CBP,WBC,B .urea, S. creatinin) Vascular (Pulses ,ABI ,Doppler,Duplex, ECG) Orthopedic (X-Ray,)

Gas Gangren

Gangrenous toe

Treatment

Patient educationAmbulationShoe wareSkin and nail careAvoiding injuryHot waterF.B’s

TREATMENT

1- Control B S. 2- Drainage ,C/S 3- Antibiotics. 4- Daily dressing. 5- Amputation.

Treatment

After surgery

Instructions

After ulcer healing Education to prevent recurrence _ Control blood sugar _ Early treatment of any infection _ Consult the surgeon when there is suspected abnormality in the foot