Case 4 - Foot problem

Question 1

Cause of diabetic foot ulceration

Answer 1

• Diabetic peripheral neuropathy = not feeling injury
• Poor healing due to lack of perfusion

Question 2

Features of osteomyelitis

Answer 2

• Pain - unable to weight bear
• Erythematous
• Swollen
• Fever
• Drainage - sinus tract/abscess
• Bacteraemia?

Question 3

Investigations for osteomyelitis

Answer 3

• FBC
• ESR and CRP
• Blood cultures
• X-ray - if needed MRI/CT PET?
• Bone samples + biopsy –> culture - gold standard

Question 4

Plain radiograph signs of osteomyelitis

Answer 4

• Cortical bone loss
• Osteopenia
• Periosteal thickening
• Endosteal scalloping
• Soft tissue swelling

COPES

Question 5

Classifying diabetic ulcer

Answer 5

SINBAD
* Site
* Ischaemia
* Neuropathy
* Bacteria
* Area
* Depth

Question 6

Common organisms involved in diabetic foot ulcer

Answer 6

• Staphylococcus aureus
• Escherichia coli
• Pseudomonas aeruginosa

Question 7

Common abx used for infected diabetic ulcer

Answer 7

• Flucloxacillin/Clarithromycin/Doxycycline/Gentamicin
• Co-amoxiclav
• Metronidazole
• Co-trimoxazole

Question 8

Multidisciplinary team involved in diabetic foot care

Answer 8

• Diabetiologist/endocrinolgist
• GP
• Diabetic nurses
• Podiatry - foot protection service
• Wound care nurse
• Surgeons - severe deformites
• Radiologists
• Dieticians

Question 9

What are steps involved in ulcer healing?

Answer 9

• Offloading - non-removable casting
• Control infection
• Control ischaemia
• Debridement
• Dressings