Diabetic foot resident survival guide

Resident Survival Guide
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ifrah Fatima, M.B.B.S[2]

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated. Diabetic foot superseded with the following may result in sepsis and death.

• Infected diabetic foot
• Osteomyelitis

Common Causes

• Poor glycemic control
• Peripheral neuropathy
  • Autonomic neuropathy
  • Somatic/Motor neuropathy
• Peripheral arterial disease
• Peripheral ischemia
• Improper footwear
• Foot deformities including Charcot arthropathy

Diagnosis

Assessment of diabetic foot includes evaluation of peripheral arterial disease, peripheral neuropathy, and foot deformities. Shown below is an algorithm summarizing the diagnosis of diabetic foot and diabetic foot ulcers according to the recommendations of the American Diabetes Association and International Diabetes Federation- Clinical Practice Recommendations on the Diabetic Foot 2017. "Guidelines".

Characterize the symptoms: ❑ Onset ❑ Type of sensation ❑ Location ❑ Nocturnal variation ❑ Aggravating factors ❑ Relieving factors Obtain a detailed history: ❑ Onset of diabetes ❑ Duration of diabetes ❑ Compliance with medication ❑ History of glycemic control ❑ History of other diabetic complcatios ❑ Foot deformities/injuries/ulcers ❑ History of lower limb amputation ❑ Type of footwear ❑ Foot hygiene ❑ History of claudication ❑ Smoking history

Examine the patient: Inspection ❑ Location of ulcer ❑ Integrity and charcteristic (dry/cracked) of skin ❑ Sweating Palpation ❑ Pedal (dorsalis pedis) pulses ❑ Vibration sensation ❑ Ulcer site- warmth, tenderness, edema Non-invasive tests ❑ Semmes-Weinstein monofilament test ❑ Probe-to-bone test if suspected osteomyelitis ❑ Measure ABI (Ankle-Brachial Index) with a Arterial doppler

Order tests: ❑ Glycosylated hemoglobin/ HbA1c ❑ Fasting plasma glucose ❑ Complete blood count ❑ ESR and CRP ❑ Deep tissue specimen for culture

Treatment

Assessment of diabetic foot includes evaluation of peripheral arterial disease, peripheral neuropathy, and foot deformities. Shown below is an algorithm summarizing the diagnosis of diabetic foot and diabetic foot ulcers according to the recommendations of the American Diabetes Association and International Diabetes Federation- Clinical Practice Recommendations on the Diabetic Foot 2017. "Guidelines".

Prophylactic measures and Diabetic foot care in all patients ❑ Glycemic control ❑ Apporpriate footwear and podiatric care ❑ Mechanical offloading • Cast Walkers • Total contact casting • Therapeutic shoes ❑ Vascular care to prevent and treat peripheral arterial disease

❑ Local wound care ❑ Debridement

Peripheral arterial disease or signs of ischemia

Medication/Surgical or endovascular revascularization

Presence of infection

• Mechanical or chemical wound debridement • Culture • Biopsy

• Assess severity of infection according to the table below • Treat with antiobiotics according to the table below

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Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.

References

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