DIABETIC FOOT

Dr. Mugaiga Apollo MBchB(Muk), MCS Trainee (COSECSA)

PROGNOSIS

• Mortality in people with diabetes and foot ulcers is often the result of
associated large vessel arteriosclerotic disease involving the coronary or
renal arteries.
• Risk factors for a lower HRQOL:
 Existence of pain,
 C-reactive protein level above 10 mg/L
Ulcer size of over 5 cm2
ABI< 0.9
High glycosylated hemoglobin level
Body mass index of over 25 kg/m2.
Prognosis continued
• Limb loss is a significant risk in patients with diabetic foot ulcers, particularly if
treatment has been delayed.
• DM is the predominant etiology for nontraumatic lower extremity amputations
worldwide.
• Half of all nontraumatic amputations are a result of DM foot complications and the
5-year risk of needing a contralateral amputation is 50%.
• In DM with neuropathy, even if successful management results in healing of the foot
ulcer, the recurrence rate is 66% and the amputation rate rises to 12%.
• CAD is the primary cause of premature death in patients with diabetic foot ulcer
• Patients with neuropathic foot ulcers were determined to have the highest risk of
premature death from ischemic heart disease.
• Invasive systemic infection associated with the Diabetic foot increases mortality
(MRSA).
CORNERSTONES OF DM FOOT ULCER PREVENTION

• Reducing the risk of ulceration reduces the risk of infection,

hospitalization, and lower-extremity amputation in DM patient

There are five key elements that underpin efforts to prevent foot ulcers:
1. Identifying the at-risk foot
2. Regularly inspecting and examining the at-risk foot
3. Educating the patient, family and healthcare professionals
4. Ensuring routine wearing of appropriate footwear
5. Treating risk factors for ulceration
Take home massage
• Untreated CLTI is associated with 22% mortality and 22% amputation
with in 1year
• Medical management of PAD is mainstay
• MT reduces to overall cardiovascular death and morbidity
• Antiplatelet (ASA) -22% reduction in major advanced cardiovascular
events
• Stattins-25% relative risk reduction in MACS
• Antihypertensive-<140/90mmHg
• Glycemic control-HBA1c <7%
References:
• IWGDF, Practical guidelines on prevention and management of
diabetic foot disease, 2019, 2023update. (Nicholas C. et al).