Diabetic Foot Neuropathy

Question 1

Complication of diabetes can predispose to foot disease - what are the 2 branches?

Answer 1

1. Neuropathy
   o sensory, motor and autonomic
2. Peripheral vascular disease

Question 2

Epidemiology of Diabetic Foot?

Answer 2

Prevalence of diabetes = 2-3%

Prevalence of current/past foot ulceration in diabetes = 5-7%

o Risk of amputation is 60x higher in diabetes
o 10% of NHS bed occupancy due to diabetes-related problems

Question 3

How can you test for Diabetic Foot?

Answer 3

Test sensory function via. a mono-filament

o when the filament bends, 10g of pressure applies which the patient should feel

Question 4

Pathway to foot ulceration?

Answer 4

1. Sensory neuropathy
   o cannot feel monofilament
   o ulcers due to abnormal pressures
2. Motor neuropathy
   o imbalance of extensors/flexors
   o SO foot is abnormal in shape
   o ulcers due to abnormal pressures
3. Limited joint mobility
   o e.g. cannot put hands flat against one another
4. Autonomic neuropathy
   o NO sweating
   o skin dries out
   o get ulcers
5. Peripheral vascular disease
   o blood flow compromised to lower limbs
6. Trauma
   o repeated OR minor episodes
7. Reduced resistance to infections
8. Other diabetic complications
   o e.g. retinopathy

Question 5

3 types of foot ulcerations

Answer 5

1. Neuropathic foot
2. Ischaemic foot
3. Neuro-ischaemic foot

Question 6

Neuropathic foot characterisitcs?

Answer 6

Numb
Warm
Dry
Palpable foot pulses
Ulcers at point of high pressure loading

Question 7

Ischaemic foot characteristics?

Answer 7

Cold
Pulseless
Ulcers at foot margins

Question 8

Neuro-ischaemic foot characteristics?

Answer 8

Numb
Cold
Dry
Pulseless
Ulcers at points of high pressure AND at foot margins

(basically both put together!)

Question 9

What should you be looking for when assessing the foot of a diabetic patient?

Answer 9

1. Appearance
   o callus? deformity?
2. Feel/touch
   o Hot/cold? Dry?
3. Foot pulses
   o dorsalis pedis/posterior tibial pulse
4. Neuropathy
   o vibration sensation? temperature? ankle jerk reflex? fine touch sensation?

Question 10

What must be managed from diabetes perspective in diabetic foot?

Answer 10

o Hyperglycaemia
o HTN
o Dyslipidaemia
o STOP smoking
o Education

Question 11

What preventative management is included for diabetic foot?

Answer 11

o Control diabetes
o Inspect feet daily
 - have feet measured when buying shoes
 - buy shoes w. lace and square toe box
 - inspect inside of shoes for foreign things

o attend chiropodist
o cut nails straight across
o care with heat
o NEVER walk barefoot

Question 12

How do you manage foot ulcerations?

Answer 12

o Relief of pressure

• bed rest (risk of DVT, heel ulceration)
• redistribution of pressure/total contact cast

o Antibiotics
- possibly long-term

o Debridement (removal of damaged tissue or foreign objects from a wound)

o Re-vascularisation
- angioplasty OR arterial bypass surgery

o Amputation

Question 13

Charcot Foot in non- and diabetics?

Answer 13

Bones orientated in an abnormal way
- deformity due to loss of joint-position sense so lose normal articulations

o PAINFUL for non-diabetics

NOT for diabetics due to sensory neuropathy

Question 14

What can Charcot Foot predispose to?

Answer 14

Abnormal shape predisposes to ulcer formation

These ulcers then predispose to osteomyelitis

Osteomyelitis - bone infection
Charcot foot - destruction of joints