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Diabetic Foot Ulcer Management

This document discusses diabetic foot problems, which are a leading cause of hospitalization for those with diabetes. Diabetic foot ulcers and infections can develop due to neuropathy, poor circulation, and foot deformities. Clinical features include loss of sensation, weakness, and skin changes. Treatment involves preventing foot problems through glucose control, foot care, and appropriate footwear. For existing ulcers or infections, treatment may include antibiotics, wound debridement, surgery to correct deformities, or amputation in severe cases. The goal is to eliminate infection and promote healing through various medical and surgical approaches.

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57 views37 pages

Diabetic Foot Ulcer Management

This document discusses diabetic foot problems, which are a leading cause of hospitalization for those with diabetes. Diabetic foot ulcers and infections can develop due to neuropathy, poor circulation, and foot deformities. Clinical features include loss of sensation, weakness, and skin changes. Treatment involves preventing foot problems through glucose control, foot care, and appropriate footwear. For existing ulcers or infections, treatment may include antibiotics, wound debridement, surgery to correct deformities, or amputation in severe cases. The goal is to eliminate infection and promote healing through various medical and surgical approaches.

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DIABETIC FOOT (LEG

ULCER)

ISMAIL BASTOMI
ORTHOPAEDIC AND TRUMATOLOGI
MOH. HOESIN HOSPITAL
UNIVERSITAS SRIWIJAYA
INTRODUCTION
 Foot problems are a leading cause of
hospitalization for the eight million persons in
the United States who have been identified as
having diabetes mellitus.

 DECREASED QUALITY OF LIFE

 MULTIDISIPLINER
 UK : 1 % POPULATION IS DIABETIC

 12 % OF DIABETIC ADMISSION ARE


WIYH FOOT PROBLEMS
PATHOGENESIS
PATOLOGI
 NEUROPHATHY
 POOR CIRCULATION
 INFECTION
CLINICAL FEAUTURE
 NEUROPHATHY :
 MOTOR : WEAKNESS OF INTRINSIC
MUSCLE
 SENSORY : PAIN OR LOSS OF
SENSATION
 AUTONOM

ULCER w/wo INFECTION :


 NEUROPHATHY
 ISCHEMI
NERVE FUNCTION
 Nylon monofilaments
(Ø5,07) can be felt 
has protective sensation
Dopler ultrasound
 ABI (ankle brachial
index)  prediction of
healing
 ABI < 1  vascular
disease
 ABI < 0,6  not
recommended to
reconstruction vascular
 Arteriografi patency and
occlusion of the arteri
 C+R

 WCC + ESR

 Plain X-ray
TABLE 1
Risk Factors for Lower Extremity Amputation in the
Diabetic Foot

• Absence of protective sensation due to


peripheral neuropathy
• Arterial insufficiency
• Foot deformity and callus formation resulting in
focal areas of high pressure
• Autonomic neuropathy causing decreased
sweating and dry, fissured skin
TABLE 1
Risk Factors for Lower Extremity Amputation in the Diabetic
Foot

• Limited joint mobility


• Obesity
• Impaired vision
• Poor glucose control leading to impaired wound
healing
• Poor footwear that causes skin breakdown or
inadequately protects the skin from high pressure
and shear forces
• History of foot ulcer or lower extremity amputation
Clasification
Wagner ulcers clasification
Grade Lesion
0 No open lesions; may have deformity or cellulitis

1 Superficial diabetic ulcer (partial or full thickness)

2 Ulcer extension to ligament, tendon, joint capsule, or deep


fascia without abscess or osteomyelitis
3 Deep ulcer with abscess, osteomyelitis, or joint sepsis

4 Gangrene localized to portion of forefoot or heel

5 Extensive gangrenous involvement of the entire foot


TREATMENT
 PREVENTIVE
 ELIMINATION OF INFECTION
 SURGERY
PREVENTION
PREVENTION
PREVENTION
 CONTROL BS REGULARLY
 DO NOT SMOKING
 INCREASED THE KNOWLEDGE OF
DIABETES
Elimination of infection
 Give AB  sign of infection
 Till the cultur has done
 Removal of bone infection
 Drainage of abscesses
 amputation
Neurophatic ulcer
 Bed rest
 Non wt bearing on crutches
 Total plaster cast
Ischaemic ulcers
 Angioplasty
 amputation
Surgery
 Debridement
 Drainage abscesses
 Removal bone infected
 Revascularisation from ischaemic foot
 Corection or resection of any fixed deformity
 Amputation
Amputation
 Toe amputation
 Ray resection
 Lysfranc amputation
 Symes amputation
 Higher level amputation
Thanks

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