Foot is a complex structure with many layers of muscles, ligaments, joints, arches, fat, thick plantar fascia, vascular arches, neurological system which maintains weight bearing, gravity, normal walk, stability and gait (swing and stance phases). & the causes or diabetic gangrene is Callosities , ulceration , Abscess , cellulitis , Osteomyelitis , Diabetic gangrene , Arthritis of the joints .

1. en love da Homoeopathy
DIABETIC
FOOT &
GANGRENE

2. DIABETIC
FOOT &
GANGRENE

3. DIABETICFOOT AND
GANGRENE
Definition
• Foot is a complex structure
with manylayersof muscles,
ligaments, joints, arches, fat,
thickplantar fascia, vascular
arches, neurological system
whichmaintains weight
bearing, gravity, normal
walk, stabilityand gait
(swing and stance phases).

4. CAUSES
• Callosities
• ulceration™
• Abscess
• cellulitis
• Osteomyelitis
• Diabetic gangrene ™
• Arthritis of the joints

5. CLASSIFICATION
Grade 0: Foot symptoms
likepain, only ™
Grade 1: Superficial ulcers ™
Grade 2: Deep ulcers ™
Grade 3: Ulcer with bone
involvement ™
Grade 4: Forefoot
gangrene ™
Grade 5: Full foot gangrene

6. FEATURES
1. Diabetic micro- angiopathy
• causes blockade of
microcirculation
leading to hypoxia.
2. Diabeticneuropathy:
• Due to sensory
neuropathy, minor
injuries are not
noticedand so
infectionoccurs.

7. 3. Line of demarcationis vague .
4. Dry, shriveled, mummified
Oedmatous, putrified,
discoloured Separation is by
asepticulceration
CAUSES
• Atherosclerosis
• TAO
• Emboli
• trauma
• Neuropathy
• Dysfunction of muscles
• arches of foot and joints
occurs.

8. PATHOGENESIS
• Diabeticatherosclerosis -
reduces the blood supply
and causes gangrene.
• Blockage occurs at plantar,
tibial, and dorsalis pedis
vessels.
• At tissue level there will be
increasedglycosylated
tissue proteins that
aggravates hypoxia.
CLINICALFEATURES
• Painin the foot.
• Ulceration.
• Absence of sensation.
• Absence of pulsations
in the foot (Posterior
tibial and dorsalis
pedis arteries).
• Loss of joint
movements.
• Abscessformation
• septicaemiaor
myocardial infarction.

9. INVESTIGATION
• Blood sugar,
• urine ketone bodies.
• Blood urea and serum
creatinine.
• X- ray - osteomyelitis.
• Pus for culture and
sensitivity..

10. TREATMENT
• Foot can be saved only if
there is good blood supply.
• Amputations of the
gangrenous area.
• Level of amputationto be
decidedby skinchanges ,
temperature changes &
Doppler study
• Footwears must be used
(Microcellular rubber).
• Feet has to be kept clean
and dry, especially the
toes and clefts
• Hyperkeratosis has to be
avoided
REFERENCE
1. SRB's Manual of Surgery
by SriramBhat M
2. A Manual on Clinical
Surgeryby Das
3. A Concise textbookof
Surgeryby Das

11. A
Special Thanks
To A Very
Special Doctor