Diabetic feet are at high risk for complications like infection, ulceration, and amputation due to neuropathy, ischemia, and infection. Neuropathy affects sensation and muscle function in the feet, leading to abnormal pressure points. Ischemia results from both large vessel atherosclerosis and microvascular damage. Together, neuropathy and ischemia allow minor injuries to become infected and progress to gangrene. Proper examination and imaging can identify the underlying causes, and treatment requires controlling diabetes, debriding wounds, administering antibiotics, and sometimes revascularization or amputation to prevent limb or life-threatening complications.
Cardiovascular Manifestations, Systemic Sclerosis by Dr. Jonathan R. Lindner MDmaushard
Presentation by Dr. Jonathan R. Lindner MD at the 13th Annual Cheri Woo Scleroderma Education Seminar on March 8, 2014 in Portland, Oregon. The seminar is a free public service hosted by the Oregon Chapter of the Scleroderma Foundation.
Peripheral artery disease is caused by atherosclerosis. Atherosclerosis is a blockage of the arteries. The blockage is fatty materials and cholesterol, also known as plaque. PAD can lead to intermittent claudication, which is pain during exercise. Peripheral artery disease can get really bad and lead to critical limb ischemia. PAD can be treated by vascular surgeons, interventional radiologists, and interventional cardiologists. It can be treated with minimally-invasive interventional radiology endovascular procedures.
PERIPHERAL ARTERIAL DISEASES- INTRODUCTION- Limb Ischemia
Dear Viewers,
Greetings from “Surgical Educator”
Today I am uploading an introductory video on “Peripheral Arterial Diseases”. In this video I have discussed the surgical anatomy, modes of presentation, symptoms, signs, investigations and a diagnostic algorithm of Peripheral Arterial Diseases. In the subsequent three videos I will discuss about chronic lower limb ischemia, acute lower limb ischemia and upper limb ischemia. I hope you will enjoy these series of teaching videos. You can watch these videos in the following links:
surgicaleducator.blogspot.com
youtube/c/surgicaleducator
Thank you for watching the video.
Cardiovascular Manifestations, Systemic Sclerosis by Dr. Jonathan R. Lindner MDmaushard
Presentation by Dr. Jonathan R. Lindner MD at the 13th Annual Cheri Woo Scleroderma Education Seminar on March 8, 2014 in Portland, Oregon. The seminar is a free public service hosted by the Oregon Chapter of the Scleroderma Foundation.
Peripheral artery disease is caused by atherosclerosis. Atherosclerosis is a blockage of the arteries. The blockage is fatty materials and cholesterol, also known as plaque. PAD can lead to intermittent claudication, which is pain during exercise. Peripheral artery disease can get really bad and lead to critical limb ischemia. PAD can be treated by vascular surgeons, interventional radiologists, and interventional cardiologists. It can be treated with minimally-invasive interventional radiology endovascular procedures.
PERIPHERAL ARTERIAL DISEASES- INTRODUCTION- Limb Ischemia
Dear Viewers,
Greetings from “Surgical Educator”
Today I am uploading an introductory video on “Peripheral Arterial Diseases”. In this video I have discussed the surgical anatomy, modes of presentation, symptoms, signs, investigations and a diagnostic algorithm of Peripheral Arterial Diseases. In the subsequent three videos I will discuss about chronic lower limb ischemia, acute lower limb ischemia and upper limb ischemia. I hope you will enjoy these series of teaching videos. You can watch these videos in the following links:
surgicaleducator.blogspot.com
youtube/c/surgicaleducator
Thank you for watching the video.
A brief presentation regarding etiology , clinical features , and management of chronic limb ischemia. It was presented by our unit at Department of surgery , Patna medical college
Diabetes Mellitus (DM) is a chronic metabolic disorder characterized by high blood sugar levels over a prolonged period. It can lead to various complications affecting multiple organ systems in the body. These complications can be broadly categorized into two types: acute and chronic. I'll provide an overview of both types below, but please note that this description will not be 3000 words long. If you need a more detailed and lengthy explanation, you may need to consult medical textbooks or academic sources.
**Acute Complications of Diabetes Mellitus:**
1. **Hypoglycemia:** This is a sudden drop in blood sugar levels, which can lead to symptoms like confusion, shakiness, sweating, and, if severe, loss of consciousness.
2. **Hyperglycemia:** High blood sugar levels can result in diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS), both of which are serious medical emergencies.
**Chronic Complications of Diabetes Mellitus:**
1. **Macrovascular Complications:**
a. **Cardiovascular Disease:** Diabetes increases the risk of heart attacks, strokes, and peripheral vascular disease due to atherosclerosis.
b. **Hypertension:** High blood pressure is common in individuals with diabetes, further increasing the risk of heart disease.
2. **Microvascular Complications:**
a. **Diabetic Retinopathy:** Affecting the eyes, this condition can lead to vision impairment and blindness.
b. **Diabetic Nephropathy:** This involves kidney damage and can eventually progress to kidney failure, requiring dialysis or transplantation.
c. **Diabetic Neuropathy:** Nerve damage can lead to symptoms like numbness, tingling, and pain in the extremities. It can also affect the digestive system and lead to gastroparesis.
3. **Dermatological Complications:**
a. **Skin Infections:** High blood sugar levels can impair the immune system, making individuals more susceptible to skin infections.
4. **Foot Complications:**
a. **Diabetic Foot Ulcers:** Neuropathy and poor blood circulation can lead to foot ulcers, which can become infected and, in severe cases, require amputation.
5. **Gastrointestinal Complications:**
a. **Gastroparesis:** This condition affects the stomach's ability to empty food properly, leading to digestive issues.
6. **Sexual Dysfunction:**
a. **Erectile Dysfunction (in men) and Sexual Dysfunction (in women):** Diabetes can impact sexual function.
7. **Mental Health Complications:**
a. **Depression and Anxiety:** Managing diabetes can be emotionally challenging, leading to mental health issues.
8. **Pregnancy Complications:**
a. **Gestational Diabetes:** This occurs during pregnancy and can lead to complications for both the mother and baby.
It's important to note that proper management of diabetes through lifestyle modifications, medication, and regular medical check-ups can help reduce the risk of these complications. Additionally, advances in medical research continue to improve ou
2. Why do you need to know about
diabetic feet?
Foot complications are the most common reason
for hospitalisation of diabetic patients
Diabetes is the leading risk factor for major
amputation
Half of all diabetics with a major amputation lose
their other leg within five years
One year survival for diabetic patients with critical
leg ischaemia is around 50%
Neuropathy, ischaemia and infection leads to
ulceration, necrosis and gangrene
3. Neuropathy
Neuropathy affects 80% diabetics
presenting with foot lesions
Sensory: deprives patient of pain reflexes
Motor: intrinsic muscles of the foot leading to
clawing of toes
Autonomic: shunting of blood, anhidrosis,
dehydration, fissuring and less elastic skin,
mineral washout from bones
4. Sesamoid bones move forward so weight borne on
metatarsal heads, especially the second metatarsal
Eventually the ankle thrown into equinus and the bones
collapse: Charcot’s foot
Load bearing then leads to pressure ulceration, made
worse by footwear
5.
6. Ischaemia
Combination of proximal occlusive atherosclerosis:
Tibial vessels more severely affected in diabetes
And distal microcirculatory failure:
Failure of endothelium to respond to vasodilators, e.g. NO
Hyperglycaemia, insulin resistance
Changes in basement membrane by products of glycation
Impaired leucocyte migration
Loss of local axon-mediated vasodilation (nuropathy)
7.
8. Infection
Can arise insidiously
Sole of foot, nailbed
Compartments of the foot constrain pus to track
backwards – not seen by patient or felt in presence of
neuropathy
Obtunded immune response and hyperglycaemia: ideal
breeding ground for synergistic infections of aerobic
and anaerobic bacterial infections
Beware gas gangrene
9.
10. Take a history
Symptoms – especially pain
Main cause for acute deterioration?
Ischaemia/neuropathy/infection
Pre-existing arterial disease?
Pre-existing neuropathy?
What is realistic goal of therapy?
11. Examination
Source for infection?
Look for osteomyelitis
Sausage shaped swelling of whole digit
Chronic discharging sinus
Easy subluxation of joints
Visible or palpable bone on probing
Neuropathy – check with cotton wool/nylon brush
Ulcer – does it bleed? i.e. has blood supply
Pulses – classically no foot pulses felt
12. Adjuncts to examination
ABPI – unreliable as incompressible pedal arteries
Doppler signal – monophasic implies significant
proximal artery occlusion
14. Treatment
Analgesia
Hydration
Oxygen
Control of diabetes
High dose antibiotics IV – Pencillin and Metronidazole.
Consider MRSA.
Wound debridement and toilet
Simple dressings: hydrogel, maggots?
VAC dressings for larger wounds
15. Revascularisation
Discuss at MDT
Distal angioplasty or bypass
Is it possible, i.e. extent of disease, presence of suitable
vein, infection (MRSA)
Distal gangrene – local amputation inc. metatarsal head
Web space gangrene – ray amputation
Major amputations can be life saving
Amputation