Diabetic Foot, Causes, Risk Factors, and Clinical Evaluation
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Diabetic Foot, Causes, Risk Factors, and Clinical Evaluation. Including Pathophysiology(Neuropathy and Peripheral Artery Disease), Clinical Evaluation(general assessment, foot exam, artery and sensation check up)
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Diabetic Foot, Causes, Risk Factors, and Clinical Evaluation
- 1. Diabetic Foot Causes, Risk Factors and Clinical Evaluation Reference: Satish Chandra Mishra et al. Diabetic foot. BMJ 2017; 359 David G. Armstrong et al. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med 2017; 376:2367-2375 Summarized By Yung-Tsai Chu
- 2. Pathway of Diabetic Foot Ulcer Poor Glycemic Control Neuropathy Peripheral Artery Disease Sensory Motor Autonomic Loss of Protective Sensation Less Sweating→ Dry Skin Foot Deformity Reference: David G. Armstrong et al. Diabetic Foot Ulcers and Their Recurrence.N Engl J Med 2017; 376:2367-2375
- 3. Risk Factors of Recurrence High Vibration Threshold Presence of Preulcerative Lesion Presence of Peripheral Artery Disease Presence of Osteomyelitis Geriatric Depression Scale >= 10 CRP > 1.5mg/dL HbA1c >7.5% Reference: David G. Armstrong et al. Diabetic Foot Ulcers and Their Recurrence.N Engl J Med 2017; 376:2367-2375
- 4. Clinical Evaluation Foot Examination Reference: Satish Chandra Mishra et al. Diabetic foot. BMJ 2017; 359 General Assessment Signs of Sepsis Visibly Unwell, Drowsy, Fever etc. Active Disease Ulcer, Rest Pain, Gangrene, Cellulitis Temp and Color Ischemia: Cold, Pale/Dusky Acute Charcot Foot: Warm, Red or Swollen Nails, Callus, Maceration, Pes Cavus, Skin Fissures, Claw/Hammer Toes, Rocker Bottom Foot, Fungal Infection Lesions or Deformities (DEF)
- 5. Clinical Evaluation Foot Examination Reference: Satish Chandra Mishra et al. Diabetic foot. BMJ 2017; 359 General Assessment Signs of Sepsis Visibly Unwell, Drowsy, Fever etc. Active Disease Ulcer, Rest Pain, Gangrene, Cellulitis Temp and Color Ischemia: Cold, Pale/Dusky Acute Charcot Foot: Warm, Red or Swollen Lesions or Deformities (DEF) Nails, Callus, Maceration, Pes Cavus, Skin Fissures, Claw/Hammer Toes, Rocker Bottom Foot, Fungal Infection Urgent Referral
- 6. Clinical Evaluation Foot Examination Loss of Protective Sensation (LOPS) Peripheral Artery Disease (PAD) Pinprick Monofilament Vibration Tuning Fork Reference: Satish Chandra Mishra et al. Diabetic foot. BMJ 2017; 359 General Assessment History of Intermittent Claudication Posterior Tibial Artery Dorsalis Pedis Artery Foot Pulses Ankle-Brachial Index < 0.9
- 7. Risk Assessment and Referrals Reference: Satish Chandra Mishra et al. Diabetic foot. BMJ 2017; 359 Presentation Management Follow-up Low Risk Callus Alone Patient Education Glycemic Control, Foot care Every Year Medium Risk 1 of Followings: Deformity, LOPS or PAD Patient Education Manage PAD ● Statin + Antiplatelet ● Exercise ● Vascular Intervention Every 3-6 Months High Risk ● Previous Amputation or Ulceration ● 2 of Followings: Deformity, LOPS or PAD Diabetic Foot Center Foot Protection Services Surgical Management Every 1-2 months