1. Diabetic foot

2. Pathophysiology
Vascular disease
Neuropathy
Sensory
Motor
autonomic

3. 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

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

5. 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

6. Autonomic Neuropathy

7. Sensory Neuropathy Loss of protective sensation
Starts distally and migrates proximally in “stocking” distribution

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

9. Gas Gangren

10. Gangrenous toe

11. Treatment Patient education Ambulation Shoe ware Skin and nail care
Avoiding injury
Hot water
F.B’s

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

13. Treatment

14. After surgery

17. 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