Diabetic foot ulcers are a major complication of diabetes and a leading cause of non-traumatic lower extremity amputations. They result from an interaction of neuropathy, abnormal foot biomechanics, peripheral arterial disease, and poor wound healing in diabetes patients. Ulcers are classified based on their depth and degree of ischemia. Treatment involves strict glycemic control, antibiotic treatment of infections, wound care including debridement and dressings, and offloading pressures on the foot. Prevention relies heavily on patient education regarding foot care, protective footwear, and monitoring for early signs of infection or other issues.

1. Dr. Soumar Dutta CDMO Guwahati Refinery Hospital

2. In diabetes slight injury to glucose laden tissues may cause chronic infection and ulcer formation. In fact DM is the leading cause of non-traumatic lower extremity amputation.

7. Depth-ischemia classification of diabetic foot ulcer Depth classification Definition Treatment 0 At risk foot, no ulceration Patient education, accommodative footwear, regular clinical examination 1 Superficial ulceration, not infected Offloading with total contact cast (TCC), walking brace or special footwear 2 Deep ulceration exposing tendons or joints Surgical debridement, wound care, offloading, culture-specific antibiotics 3 Extensive ulceration or abscess Debridement or partial amputation, offloading, culture-specific antibiotics

8. Ischemia classification DEFINITION TREATMENT A NOT ISCHEMIC B ISCHEMIA WITHOUT GANGRENE Noninvasive vascular testing, vascular consultation if symptomatic C PARTIAL(FOREFOOT) GANGRENE VASCULAR CONSULTATION D COMPLETE FOOT GANGRENE Major extremity amputation, vascular consultation

12. Osteomyelitis is a prevalent sequel of diabetic foot ulcers. The timing of its diagnosis and treatment is crucial if the diabetic patient is to avoid amputation later . Fig : Osteomyelites at the head of first metatarsal bone

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