Diabetic Foot And Diabetic Foot Infection

Patients with diabetes mellitus are more prone to develop foot infections due to….

  • Diabetic neuropathy
  • Peripheral arterial disease


These patient can have a vast spectrum of presentation from soft tissue infection to bone infection


Management Of Diabetic Foot Infection

Presentation

  1. Long standing history of diabetes mellitus 
  2. Pain in the limb (May not have pain due to neuropathy)
  3. Fever 
  4. Malaise 
  5. Rise of temperature
  6. Tender, erythematous, swollen with local rise of temperature 
  7. Firm in consistency
  8. Vesicles may be present 
  9. In anaerobic infection – Crepitations may be felt 
  10. Discharge may be present 
  11. Lymphangitis may be present 
  12. If it develops to osteomyelitis, patient may complain of severe pain in the limb (If neuropathy has not developed) or in chronic cases multiple discharging sinuses will be present 


Investigations

  1. Full blood count
    • Leukocytosis 
  2. Pus is sent for culture and sensitivity 
  3. X-Ray of the affected limb – In suspected osteomyelitis
 
Treatment
  1. Bed rest
  2. Elevation of the limb to reduce oedema of the affected part
  3. Parenteral broad spectrum antibiotics 
  4. If abscess is formed – Incision and drainage 
  5. Regular dressing of the wound
  6. Strict control of diabetes 



A patient presented at Bangabandhu Memorial Hospital (BBMH), chittagong with a history of diabetes for 4+ years and a non traumatic wound in the left heel and on the lateral aspect of left foot.
On admission patient was receiving medication for diabetes mellitus though it was uncontrolled

On the day of admission

 
 
 
 
After three days of admission

 




Diabetic Foot

Diabetic foot is one of the most significant and devastating complications of diabetes, and is defined as a foot affected by ulceration that is associated with neuropathy and/or peripheral arterial disease of the lower limb in a patient with diabetes.


Classification Of Diabetic Foot

Diabetic foot can be classified as (According to origin)

  1. Neuropathic – 45%
  2. Ischaemic – 10%
  3. Neuro-ischaemic – 45%


Neuropathic wounds are usually healed over a period of 20 weeks
Neuro-ischemic ulcers take longer and often lead to limb amputation


Difference Between Types Of Diabetic Foot

Traits
Neuropathic Ulceration
Ischaemic / Neuro-ischaemic Ulceration
1. Peripheries Warm foot Cold foot
2. Pulse Palpable Absent
3. Sensory loss Present Absent
4. Secondary infection Usually absent
Usually present

Cellulitis may be present

5. Duplex imaging Normal / high
Reduced blood flow

Ankle Brachial Pressure Index (ABPI) is high



Key Features Of Diabetic Foot

  1. Ulceration
  2. Infection
  3. Sensory neuropathy
  4. Failure to heal trivial injuries 



Pathogenesis Of Diabetic Foot

  1. Diabetic neuropathy
    • It affects motor, sensory and autonomic fibers
    • Motor neuropathy – Muscle weakness, paresis and atrophy
    • Sensory neuropathy – Sensory loss of pain, heat and pressure may result in minor repetitive trauma 
    • Autonomic dysfunction – Vasodilation and decrease sweating resulting in loss of skin integrity and increase risk of infection 
  2. Peripheral arterial disease
  3. Structural foot deformities and abnormalities predispose ulcer formation
  4. Previous foot ulceration or amputation
  5. Visual impairment
  6. Poor glycemic control
  7. Cigarette smoking 



Management Of Diabetic Foot

Prophylactic management 

  1. Multidisciplinary team approach 
  2. Regular foot inspection for evidence of pressure / ulceration 
  3. Use appropriate wide fitting footwear 
  4. Regular nail care 
  5. Removal of callus skin 
  6. Avoid walking barefooted 
  7. Strict control of diabetes 

Management of an established ishcaemic ulceration
  1. Bed rest 
  2. Elevation of the limb to reduce oedema 
  3. Broad spectrum antibiotics 
  4. Debridement of the dead tissues 
  5. Drainage of pus
  6. Regular dressing of the wound
  7. Revascularization, if necessary  
    • Angioplasty 
    • Femoro-distal bypass grafts 
  8. If medical or surgical treatment fails, amputation can be carried out 
 
Fig : Diabetic Foot
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Laura Bush
1 year ago

asdad

Laura Bush
1 year ago

asdad