Flashcards in Chronic arterial insufficiency Deck (43)
What are the features of diabetic foot?
Infection (cellulitis, abscess, osteomyelitis)
Failure to heal trivial injuries
Name 4 risk factors for ulceration in diabetic foot
Neuropathy (stocking distribution and Charcot foot)
Peripheral arterial disease - frequently highly calcified
Altered foot shape
Callus - high foot pressures
What are the causes of ulceration in diabetic foot?
Ischaemia of large or small vessels (10%)
Mixed neuropathic-ischaemic origin (45%)
Describe the presentation of diabetic foot with pure neuropathic ulceration
Warm foot with palpable pulses
Ulceration at pressure points
Evidence of sensory loss ➔ unrecognised repeated trauma
Normal or high duplex USS flow
Describe the presentation of diabetic foot with ischaemic or mixed ulceration
Foot may be cool
Ulcers commonly on toes, heel, metatarsal
Secondary infection with minimal pus and mild cellulitis
ABPIs may be misleadingly high due to calcification (diabetes)
Low duplex USS flow
What investigations can be used to differentiate the causes of diabetic foot ulceration?
Ankle/brachial pressure index
Angiography - suspected critical limb ischaemia
Outline prophylactic management of ulceration in diabetic foot
Specialist diabetes foot clinic with MDT
Regular foot inspection
Nail care with chiropody
Debridement of calluses
Keep foot cool
Avoid walking barefoot
Outline management of infection in established ischaemic ulceration
Treat local or systemic infection following trust ABX guidelines
Debride/amputate any necrotic tissue
X-ray for osteomyelitis
What surgical options are available for diabetic foot?
Femoro-distal bypass graft
What surgical considerations must be made for diabetic patients?
Renal disease: close monitoring of hydration, BP and eGFR
Metformin stopped 48hr prior to angiography due to risk of lactic acidosis
T1DM require sliding scale when NBM
Elevate legs to avoid pressure sores
Prompt attention to any skin breaks
What infections may occur in poorly managed ulcerations of diabetic foot?
Deep tissue infections - plantar abscess
What is the management of osteomyelitis of the toe or metatarsal?
Ray excision - surgical removal of toe and metatarsal