Diabetic foot and Foot care Dr Joel Arudchelvam Definition Prevalence Teaching Hospital Anuradhapura [THA] High risk foot Neuropathy Pathogenesis of neuropathy Charcot foot Testing for neuropathy Local Ulcer care

1. Diabetic foot and Foot care
Dr Joel Arudchelvam
MBBS (COL), MD (SUR). MRCS (ENG), FCSSL
Consultant Vascular and Transplant Surgeon,
Senior lecturer, department of Surgery, faculty of medicine, University of Colombo.

2. Diabetic foot
Infection, ulceration or destruction tissues and
bones with associated neuropathy and
occlusive arterial disease in a patient with DM
( WHO definition)

3. Diabetic mellitus
▪ Sri Lanka
▪ In 2005 - diabetes mellitus
� 14.2 % males
� 13.5 % females

4. Diabetic foot
▪ Teaching Hospital Anuradhapura [THA]
▪ 100 patients
▪ 81 [81%] males
▪ mean age - 67.6 years
▪ Diabetes mellitus - 65 [65%]
Arudchelvam, J. and De Soyza, M., 2022. Pattern of occlusive disease in lower extremity arteries in patients qualifying for
revascularization in a North Central Province tertiary care centre in Sri Lanka. Sri Lanka Journal of Surgery, 40(2), p.20-
23.DOI: https://doi.org/10.4038/sljs.v40i2.8794

5. Diabetic foot
▪ University of Colombo
▪ Diabetes mellitus -
80%

6. Diabetic foot
▪ 4% -10% foot ulcer risk in DM
▪ 40% - 60% of all lower limb amputation
▪ 85% of amputation are preceded by foot ulcer

7. Diabetic foot
▪ Neuropathy
▪ Ischemia
▪ Infection
▪ Ulcer
▪ Bone destruction

8. High risk foot
• History:
Previous ulcer/lower extremity
amputation, claudication
• Absence of pedal pulses
• Loss of protective sensation

9. Neuropathy
▪ Prevalence
� 7% within 1 year of diagnosis
▪ 50% >25 years

10. Neuropathy
• Increased risk for:
Foot ulceration
amputation
Neuropathic pain
Significant morbidity
Usage of resources

11. Pathogenesis of neuropathy
▪ Progressive nerve fiber loss
▪ Mechanisms
� Polyol pathway – hyperglycaemia - glucose to
sorbitol
� Advanced glycation end products (AGEs)

12. Neuropathy
▪ Sensory – Glove and stocking type
▪ Motor
▪ Autonomic

15. Ischemia
▪ Increased atherosclerosis
▪ Vascular disease
� Ulcer
� Gangrene

16. Ulcer
▪ In distal part of limb (forefoot or toes)
▪ Dry
▪ painful

17. Gangrene
▪ Death of tissue with infection
� Dry – infection is limited to dead tissue and the margins
� Wet - infection extends up

20. Charcot foot
▪ Due to reduced pain sensation and proprioception
▪ Resulting in
� Fracture
� joint destructions
� Collapse of the arch of the foot
� Inflammation ar

22. Osteomyelitis

23. Testing for neuropathy
▪ Pressure perception
� Semmes-Weinstein 10 gram monofilament
▪ Vibration perception:
� 128 Hz tuning fork

24. Semmes-Weinstein 10 gram
monofilament

26. Prevention and management
Patient education

27. Neuropathy - off loading

28. Nail cutting

29. Foot wear

30. Foot wear

31. Local Ulcer care
∙ Wound toilet
o Process of removal of slough, dead tissue, foreign bodies and
draining pus.
o Following a wound toilet the wound base is made suitable for future
granulation and epithelialisation.

35. Detection of ischemia and
Revascularisation

36. Bypass

37. Angioplasty and/ Stenting

38. Avoid
• Do not apply gauze bandage tightly around limbs, digits –
causes ischaemia
• Use – plaster , crepe instead

39. Summary
▪ Diabetes mellitus is a leading cause of limb
loss
▪ Identification of high risk foot and prevention
of ulcers is the mainstay of management

40. Thank You