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Flashcards in Chronic arterial insufficiency Deck (43)
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31

What are the features of diabetic foot?

Ulceration
Infection (cellulitis, abscess, osteomyelitis)
Sensory neuropathy
Failure to heal trivial injuries

32

Name 4 risk factors for ulceration in diabetic foot

Previous ulceration
Neuropathy (stocking distribution and Charcot foot)
Peripheral arterial disease - frequently highly calcified
Altered foot shape
Callus - high foot pressures
Visual impairment
Living alone
Renal impairment

33

What are the causes of ulceration in diabetic foot?

Neuropathy (45%)
Ischaemia of large or small vessels (10%)
Mixed neuropathic-ischaemic origin (45%)

34

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

35

Describe the presentation of diabetic foot with ischaemic or mixed ulceration

Foot may be cool
Absent pulses
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

36

What investigations can be used to differentiate the causes of diabetic foot ulceration?

Ankle/brachial pressure index
Duplex USS
Angiography - suspected critical limb ischaemia

37

Outline prophylactic management of ulceration in diabetic foot

Specialist diabetes foot clinic with MDT
Regular foot inspection
Wide-fitting footwear
Nail care with chiropody
Debridement of calluses
Keep foot cool
Avoid walking barefoot

38

Outline management of infection in established ischaemic ulceration

Treat local or systemic infection following trust ABX guidelines
Debride/amputate any necrotic tissue
Drain pus
X-ray for osteomyelitis

39

What surgical options are available for diabetic foot?

Angioplasty
Femoro-distal bypass graft
Amputation

40

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

41

What infections may occur in poorly managed ulcerations of diabetic foot?

Deep tissue infections - plantar abscess
Osteomyelitis

42

What is the management of osteomyelitis of the toe or metatarsal?

Ray excision - surgical removal of toe and metatarsal

43

What may cause the ABPI reading to be erroneously elevated?

Calcification of arteries - seen in diabetes