DIABETIC FOOT ULCER

Mardhati Ab Rahman
012011100026

WHAT IS DIABETIC FOOT ULCER?

Any infection involving the foot in a

person with diabetes originating in a
chronic or acute injury to the soft
tissues of the foot, with evidence of
pre-existing neuropathy and/or
ischemia.
-International Consensus on
Diagnosing and Treating the Infected
Diabetic Foot (2003)-

EPIDEMIOLOGY

Occur in 15% of diabetic patient

40% of non-trauma related
amputations are for
complications of diabetes

RISK FACTORS

1. Predisposition to peripheral
vascular disease
2. Peripheral neuropathy
3. Reduced resistance to
infection
4. Osteoporosis

Pathophysiolo
gy
Peripheral vascular Disease
Patient may complain of
intermittent claudication or ischemic
changes and there may be
ulceration, or worse still, gangrene
in the foot
It commonly affects the tibial and
peroneal arteries of the calf

Pathophysiolo
gy
Peripheral Neuropathy
Motor

Damage to the innervations of the

intrinsic foot muscles
imbalance between flexion and
extension of the affected foot
anatomic foot deformities that
create abnormal bony prominences
and pressure points
(claw toes with high arch) skin
breakdown and plantar ulceration

Pathophysiolo
gy
Neuropathy
Autonomic

Autonomic neuropathy diminution

in sweat and oil gland functionality
the foot loses its natural ability to
moisturize the overlying skin and
becomes dry and increasingly
susceptible to tears and the
subsequent development of infection

Pathophysiolo
gy
Neuropathy
Sensory

First sensation lost is vibration and

proprioception
Patients are often complain of
paraesthesia or symmetrical
numbness and unable to detect the
insult to their lower extremities
many wounds go unnoticed and
progressively worsen as the affected
area is continuously subjected to

PATHOPHYOLOGY
Infection
Uncontrolled diabetes reduces
immunity and in combination with
peripheral neuropathy and ischemia,
increases the risk of infection after
minor trauma

PATHOPHYSIOLOGY
Osteoporosis
Loss of bone density in diabetes
may be severe enough to result in
insufficiency fractures around the
ankle or in the metatarsals

C LA SS IFIC ATIO N A N D S Y M P TO M S O F
D IA B ETIC FO O T U LC ER , C H A R C O T
FO O T

AMALINA BT AZMAN
012012100140

SYMPTOMS OF
DIABETIC FOOT
ULCER
Peripheral
Neuropathy

Hypaesthesia
Hyperesthesia
Paresthesia
Dysesthesia
Radicular pain
Anhydrosis

Peripheral
Insufficiency

Usually asymptomatic
Intermittent claudication
Ischemic pain at rest
Non-healing ulceration of
the foot

CHARCOTFOOT
Occur in less than 1% of diabetic patient
A relatively painless, progressive and degenerative
arthropathy of single or multiple joints caused by
an underlying neurological deficit.
It is a neuropathic joint disease causing weakening
of the bones(bone destruction, resorption and
deformity) in the foot that can occur in people who
have significant neuropathy.
The bones are weakened enough to fracture, and
with continued walking the foot eventually
changes shape.
Most commonly affect midtarsal joints, metatarsal
phalangeal joint and ankle joints

CLINICAL FEATURES

It varies depending on the stage of

the disease from mild swelling to
severe swelling and moderate
deformity.
Intact skin, Inflammation, erythema,
pain and increased skin temperature
(37 degrees Celsius) around the joint
may be noticeable on examination.
X-rays may reveal bone resorption
and degenerative changes in the

INVESTIGATIO
N&
TREATMENT
DINIE HAZIRAH BINTI
HASAN
012012100161

INVESTIGATIONS

Full blood count

HbA1c
Renal Profile
Fasting blood sugar
Doppler studies and ultrasound
Imaging

Transcutaneous

ANKLE-BRACHIAL PRESSURE INDEX

(ABPI)

The ankle-brachial pressure index

(ABPI) or ankle-brachial index (ABI) is
the ratio of the systolic blood pressure in
ankle to brachium
Lower leg BP is indicative of arterial
blockage due to peripheral artery disease
The patient must be placed supine,
without the head or any extremities
dangling over the edge of the table

Method ABI

Interpretation ABI

Radiographs

TREATMENT
General factors important in deciding
treatment plan include :
angiopathic vs. neuropathic
deep vs. superficial
+/- osteomyelitis, antibiotics based on
bone biopsy culture sensitivities

Non-operative
act as a barrier
absorb
provide moist
off-load
pressure
environment
at ulcer
act as a moist
provide
barrierenvironment
First line of treatment
Goals
off-load
of wound
pressure
care and
at ulcer
dressings is to :Goals
absorb
of wound care and dressings is to :-

Has marginal
adequatearterial
blood supply
supplyand
to affected
ability to
area
monitor patient at interval of
Has patients
adequate
unable
blood to
supply
comply
andwith
ability
casttocare
monitor patient at interval of
Gold Standard for mechanical relief plantar ulcerations
Contraindications
Total Contact
patients
Casting
unable
(TCC)
to comply with cast care
Absolute infection
patients unable
marginal
arterialtosupply
tolerate
to affected
a cast (cast
areaclaustrophobia)
Total Contact
patients
Casting
unable
(TCC)
to tolerate a cast (cast claustrophobia)
Contraindications
Gold
Standard for mechanical relief plantar ulcerations

Shoe modification
prevention when signs of potential ulcers are
present includes deep or wide shoes, custom
insoles, rocker bottom soles (the best to reduce
plantar pressure on the forefoot)

Life style modification

Glucose to be kept under control
Blood pressure control
Lipid management
Smoking cessation

Foot care guide

Operative

Surgical debridement, antibiotics, local wound care, contact cast

THANK
YOU