DIABETIC FOOT PROBLEMS

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DIABETIC FOOT PROBLEMS
SIAM TONGPRASERT, M.D.
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Definition of diabetic foot

• A group of syndromes in which neuropathy,
  ischemia and infection lead to tissue breakdown,
  resulting in morbidity and possible amputation

World Health organization
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DIABETIC FOOT PROBLEMS
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DIABETIC FOOT PROBLEMS

• 51 of all nontraumatic amputation
• 55 of the patients require amputation of the
  contralateral leg within 2-3 years
• Two thirds of diabetics die within 5 years after
  initial leg amputation

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ETIOPATHOGENESIS OF DIABETIC FOOT ULCERS

• Combination of causes rather than a single cause
• Neuropathy
• Ischemia
• Infection
• Mechanical stress

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(Precipitating factors)
(perpetuating factors)
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NEUROPATHY

• 12 of patients at the time of diagnosis
• Prevalence rate of 42 - 80 for individual
  with less than 5 years and greater then 15 years
  duration
• Distal symmetircal sensory motor neuropathy
• Autonomic neuropathy

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SENSORY MOTOR NEUROPATHY

• Sensory Lack of protective sensation
• Motor Intrinsic foot muscle dysfunction,
  resulting in deformity
• Claw toe

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• Hammer toe
• Metatarsophalangeal joint subluxation

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AUTONOMIC NEUROPATHY

1. Impaired sweat and sebaceous gland secretion with
   resultant dry, cracked skin with fissure
2. Portal entry for bacteria

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ISCHEMIA

• Diabetic macroangiopathy
• Popliteal, Tibial, peroneal, and superficial
  femoral arteries
• 64 digit
• 16 heel
• 10 dorsum of the foot
• 10 metatarsal head

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INFECTION

• Defective leukocytosis with impaired
  intracellular bacterial killing
• Poor antibiotic perfusion of the infect area
  secondary to ischemia

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MECHANICAL STRESS

• High-pressure penetrating injury
• Low pressure applied for a prolonged period of
  time
• Repetitive stress of walking

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(precipitating factors)
(perpetuating factors)
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Physical examination
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Physical examination
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• Toe pressure
• Normal 90-100 mmHg
• 20-30 mmHg less than ankle pressure
• lt 30 mmHg rest pain and/or skin lesion

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• Transcutaneous oxygen pressure (TcPO2)
• Normal 40-70 mmHg
• 0-30 mmHg rest pain or gangrene
• lt 40 mmHg failure of wound healing

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TREATMENT

1. HEALING OF EXISTING FOOT WOUNDS
2. PRERVENTION OF RECURRENT AND NEW LESIONS

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WOUND CARE

• Three factors
• The presence of infection
• Insufficient circulation
• Inadequate relief of pressure

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Charcots foot

• Neuropathic osteoarthropathy
• Progressive condition characterized by joint
  destruction, pathological fracture and severe
  disruption of foot architecture
• Incidence
• Unilateral (0.08-7.7)
• Bilateral (5.9-39.3)

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THANK YOU