1
4th stage
Surgery
Lec
Dr.Ahmad
Diabetic foot
Pathophysiology
• Vascular disease
• Neuropathy
• Sensory
• Motor
• autonomic
Vascular Disease
• Diabetics get arthrosclerosis due to calcification of the media
• Often increased blood flow with lack of elastic properties of the arterioles
• 30 times more prevalent in diabetics
Neuropathy
• Changes in the vasonervorum with resulting ischemia.
• Abnormalities of all three neurological systems contribute to ulceration.
Autonomic Neuropathy
• Regulates sweating and perfusion to the limb
• Result is dry, scaly and stiff skin that is prone to cracking and allows a portal of entry
for bacteria
2
Sensory Neuropathy
• Loss of protective sensation
• Starts distally and migrates proximally in “stocking” distribution
Patient Evaluation
• Medical (FBS,GUE,CBP,WBC,B .urea, S. creatinin)
• Vascular (Pulses ,ABI ,Doppler,Duplex, ECG)
• Orthopedic (X-Ray,)
Gas Gangren
Gangrenous toe
3
Treatment
1- Patient education
– Ambulation
– Shoe ware
– Skin and nail care
– Avoiding injury
• Hot water
• F.B’s
2- Control B S.
3- Drainage ,C/S
4- Antibiotics.
5- Daily dressing.
6- Amputation.
4
Instructions
After ulcer healing
Education to prevent recurrence
Control blood sugar
Early treatment of any infection
Consult the surgeon when there is suspected abnormality in the foot