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Diabetic Foot Ulcer and Treatment.

i am a registered general surgeon . having experience in dealing with such cases.

DIABETIC FOOT INTRODUCTION:

Diabetic foot ulcer is a condition in which an infected sore or ulcer develop on foot of diabetic patients. chronic diabetes can cause damage to nerves and vessels which lead to decrease sensation of pain in feet and decrease blood flow. both these condition are major cause of ulcer formation.Diabetic foot ulcer is a major cause of morbidity and mortality. People become socially dependent.

Diabetic foot ulcer.

diabetic foot ulcer

diabetic foot ulcer

WHO CAN DEVELOP DIABETIC FOOT ULCER?

AT RISK GROUP:

Patients with dirty feet, poor hygiene and poor glycemic control are high risk to develop diabetic complications like damage to nerves and vessels. These complications can lead to decrease blood flow to feet and decrease sensation for pain and pressure. So this group of patients is at high risk to develop diabetic foot ulcers.

RISK FACTORS:

  1. Uncontrolled diabetes.
  2. Poor hygiene and poor quality footwear's.
  3. poor blood flow .
  4. Obesity.
  5. Smoking.
  6. Decrease sensation of pain and pressure.

ASSESSMENT:

All patients with Diabetes should be assessed for diabetes foot at risk. For assessment we have to do

patient foot examination.

ask the patient about symptoms.

nerve damage assessment.

vascular blood flow assessment.

Diabetic foot Diagnosis and Management /Treatment.

SYMPTOMS:

  1. patients present with numbness in foot.
  2. pain on walking
  3. pain on rest.
  4. loss of hairs on legs and feet.
  5. small boil on foot.
  6. little sore which do not heal .
  7. infected ingrowing nail.
  8. color changes .
  9. smelly wound discharge on feet.
  10. patients with other co-morbid conditions.

.DIAGNOSIS:

when a patient present with elevated blood sugar levels and diabetic foot symptoms , diagnosis is made after complete history, examination, risk assessment, biochemical tests and radio-logical assessment of foot .

MANAGEMENT AND TREATMENT:

Diabetic Foot Ulcer management needs a multidisciplinary approach. Often patients are in denial of their disease and fail to take ownership of their illness along with the necessary steps to prevent complications and to deal with the many challenges
associated with the management of Diabetic Foot Ulcer. Management of Diabetic Foot Ulcer includes:

  • optimal blood glucose control,
  • prevention through education,
  • foot off loading , prevent pressure sore.
  • treatment.

TREATMENT:

Lesions and ulcers detected during a foot check should be initially treated . It is recommended that patients identified as being at increased risk of serious foot complications are then referred to a specialist multidisciplinary
team for further management and care. Treatment can be only wound wash or debridement in some cases. if wound get infected and getting well by debridement than amputation can be done.

wagner classification.

treatment according to grading

GradePresentationTreatment

0

high risk

prevention

1

superficial ulcer

antibiotics and glycemic control

2

deep ulcers, to bone, ligament or joint

debridement ,antibiotics and glycemic control

3

deep abscess, osteomyelitis

debridement , some form of amputation

4

gangrene of partial foot

wide debridement and amputation.

5

whole foot gangrene

below knee amputation.

DIABETIC FOOT GRADING:

DIABETIC FOOT GRADING.

DIABETIC FOOT GRADING.

PATHOBIOLOGY OF DIABETIC FOOT

PATHOBIOLOGY OF DIABETIC FOOT

WHAT TO DO ? PREVENTION ?

STEPS TO SAVE LIFE.

  1. control blood sugar levels.
  2. strict diet control.
  3. daily examine your feet.
  4. decrease weight.
  5. stop smoking.
  6. early consultation for diabetic foot ulcer/sore.
  7. foot hygiene .
  8. good quality foot wears .
  9. proper nail care.


DIABETIC FOOT CARE

DIABETIC FOOT CARE

DIABETIC FOOD CHART

DIABETIC FOOD CHART

AMPUTATION ,DISABILITY and REHABILITATION.

AMPUTATION:

Infected part of foot which is not curable is removed surgically is called amputation. it can be at any level like a single toe or fore foot or whole foot and some time half leg.

DISABILITY :

it is physical or mental condition which limits a person movements , senses and activities. in diabetic patients it is multi factorial,

  • long term hospital stay.
  • dependency for wound care.
  • inability to move due to pain or amputation.
  • lack of earning due to hospitalization.
  • lack of movements after amputation.
  • lack of motivation.
  • old age .

REHABILITATION:

  • rehabilitation starts before the amputation.
  • involving physiotherapy department before amputation for planing .
  • is there any need for artificial limb or not.
  • is the patient need shoes modification.
  • is he/she need psychological support.
  • early physiotherapy after amputation enhance recovery.
  • counselling for occupation.
  • social support.

Questions

For each question, choose the best answer. The answer key is below.

  1. who can we prevent diabetic foot ulcer.
    • we can prevent diabetic foot ulcer by educating population about diabetes and diabetic foot ulcer .
    • we have to teach population about daily examination of feet to see any sore or ulcer .
  2. how can we modify our risk factors
    • all diabetic patients should have to reduce there weight .
    • all diabetic patients should have to control there blood sugar.

Answer Key

  1. we can prevent diabetic foot ulcer by educating population about diabetes and diabetic foot ulcer .
  2. all diabetic patients should have to reduce there weight .

© 2019 dr muhammad amir qadeer

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