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 sensation Starts 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 education Ambulation Shoe ware Skin and nail care Avoiding injury Hot water F.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