Flashcards in Assessment and Management of a Foot Ulcer Deck (12):
What is the most common reason for a pt with diabetes to be admitted to hospital?
Foot ulceration (also the most common indication for amputation in the entire population)
What microvascular complications are relevant to the development of a diabetic foot ulcer?
Sensory neuropathy: loss of sensation leading to trauma, instability
Motor neuropathy (often later): wasting of intrinsic muscles of foot, wasting of long flexors and extensors, reduced joint mobility (all contribute to "clawed" deformity of foot which can cause pressure ulcers)
Autonomic neuropathy: sweat glands (dry skin, leads to cracking), small arteries and veins (AV shunting)
What diabetic complications are relevant to the development of a foot ulcer?
Neuropathy (both sensory and mechanical deformity)
Increased susceptibility to infection
What organisms are typically seen in diabetic foot ulcers? How does this mean for treatment?
Typically polymicrobial: skin commensals, anaerobes, Gram negatives
Requires broad spectrum Abs; may need drainage and debridement
How can tissue perfusion be assessed?
Clinically: signs of perfusion (Ps), palpation of pulses (can help localise arterial disease), ABI (not reliable if artery is calcified and therefore can't compress tibial vessels), toe pressure (more accurate in the case of calcification; good indicator of arterial potential of wound healing), duplex US?
Relevance of nephropathy to management of diabetic foot ulcer
Can impact healing
Impact of contrast if ordering angiogram
Removing pressure from ulcer sites
Plaster cast is gold standard treatment but usually not first-line due to evidence of infection
Boot, usually with padding on bottom of foot or around ulcer
Post-op surgical shoe if not tolerated
4 stages of pressure ulcers
1: Non-blanching erythema
2: Closed fluid-filled blister
3: Erupted blister
4: Bone and tendon visible
May be maroon with suspected deep tissue injury
May be unstageable if lots of slough and necrotic tissue
Offloading pressure ulcers
Elevation of leg: soft boot with heel hanging out
Positive swab for e.g. Pseudomonas: diagnostic for infection?
Not diagnostic, could just be colonisation
Diagnosis of infection requires markers of infection, both clinical and on further Ix