Diabetic foot

2. Diabetic
Foot
AbdelAziz Fareed Asaly
2031040060
Nasser Hashim Ali Al-Ali
2031040062
Supervised by :
Prof. Lade Wosornu

3. What is the diabetic foot?
 It is a spectrum of foot disorders ranging from
ulceration to gangrene occurring in diabetics
as result of peripheral neuropathy or ischemic
or both.

4. Why is it important?
 Because the foot is a frequent site for
complications in patients with diabetes.
 Tissue necrosis in the feet is a common
reason for hospital admission in diabetic
patients. Such admission tend to be
prolonged and often end with amputation.

5. Causes of diabetic foot
1. Ischemic or Angiopathy
2. Neuropathy
3. Infection

6.  Neuropathy and blood
vessel disease both
increase the risk of foot
ulcers . Because of the loss
of sensation caused by
neuropathy, sores or injuries
to the feet may not be
noticed and may become
ulcerated.

7. Infection
 such as cellulitis are caused by the same
organisms as those in healthy hosts, namely
group A streptococci and Staph aureus.
 If the patient is hyperglycemic, this will be
good media for polymicrobial infection.

8. Summary
 Angiopathy  ischemia  ulcer or gangrene,
if infected wet gangrene
 Neuropathy Injury + loss of sensation 
ulcers and gangrene without noticing

9. Factors that interferes with
Wound Healing
 Vascular [Atherosclerosis,Poor blood supply,
Microthrombi]
 Neurologic [loss of sensation]
 Infection [Inadequate
debridement,Hyperglycemia, Decreased
neutrophil function, Polymicrobial infection,
Immunosuppression ]
 Mechanical [Edema, Weight bearing ]
 Poor nutrition

10. Clinical presentations of
diabetic foot
 Cellulitis
1. Erythema
2. Tenderness
3. Hot (warm)
4. Swelling of the foot (edema)
5. Fungal infection
 Hairless

11. Clinical presentations of
diabetic foot
 Foot ulcers
 Acute ( bleeding )
 Chronic ( slough in the floor,
thickening of the edge, no
bleeding )
1. Neuropathic
2. ischemic

12. Clinical presentations of
diabetic foot
 Gangrene
 Dry gangrene
 Wet gangrene
 Gas gangrene

13. 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

14. Differential diagnosis:
1. Wet gangrene
2. Atherosclerosis
3. Arteritis
4. DVT with venous gangrene
5. Varicose veins
6. Venous ulcer
7. Malignant ulcer
8. Traumatic ulcer

15. Diagnosis
 Evaluation on three levels: the patient,
wound, and infection.
 History and physical examination [ inspection,
palpation]
 Foot pulse, blood pressure
 Neurological examination

16. Investigation
 Lab Studies:
1. CBC count
2. erythrocyte sedimentation rate (ESR
3. Blood culture
4. platelet count

17.  Imaging Studies:
1. plain radiography
2. CT scan  for deep abscess, gas
gangrene
3. MRI  detection of osteomyelitis
4. Check blood vessels by Doppler
ultrasound, angiography.
Investigation

20. Management of diabetic foot
 Debridement [ to remove necrotic tissue ]
 Treat infection [ampicillin, gentamycin, fungal]
 Avoid weight-bearing
 Ensure good diabetic control
 Control edema
 Angiogram to assess feasibility of vascular
reconstruction where indicated

21. MAJOR OUTCOMES
CONSIDERED
 Severe morbidities
 Amputation
 Hospital length of stay
 Financial burden

22. Prevention begins with:
 Daily foot inspections (Look for redness,
cracks in skin, or sores.)
 Daily foot care (Dry completely between your
toes and use lotion to keep skin moist.)
 Regular visits to your physician
 Foot-care education
 Wearing proper shoes at all times (Do not go
barefoot.)
 Early treatment of any trouble areas.

23.  People with diabetes should have a foot
exam every year. Exams include:
1. Checking for sensation (feeling) in the feet
2. Looking at the foot for changes in shape
and size
3. Checking blood flow and circulation
4. Looking for discoloration.
Prevention begins with:

24. Thank You For
Listening