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Flashcards in Diabetic Foot Deck (16)
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1
Q

How do diabetic foot ulcer’s occur?

A
  • Diabetic neuropathy - patient unaware of trauma + dry cracked skin due to lack of sweat
  • Skin more sensitive to minor trauma
  • Poor vascular supply - impairs healing process
3
Q

What percentage of diabetics will develop ulceration?

A

15%

4
Q

What are the modifiable determinants of healing of a diabetic foot ulcer?

A
  • Diabetic control
  • Smoking
  • Vascular supply
  • External pressure modification
  • Internal pressure (deformity)
  • Infection
  • Nutrition
5
Q

What is the 5 year mortality for those who develop diabetic foot ulcers?

A

50%

6
Q

What percentage of those that develop diabetic foot ulcers go on to have the foot amputated?

A

25%

7
Q

What is Charcot’s arthropathy?

A

Progressive degeneration of a weight bearing joint, a process marked by bony destruction, bone resorption, and eventual deformity.

8
Q

What is the following?

A

Diabetic Foot Ulcer - Complication of diabetes

9
Q

The following deformity was found in someone with diabetes. What is the name of this deformity?

A

Charcot’s Foot

10
Q

What are thought to be the processes behind the development of Charcot’s Arthropathy?

A
  • Neurotrauma: Loss of peripheral sensation and proprioception ⇒ repetitive microtrauma ⇒ resultant inflammatory resorption of traumatized bone leaves region weak and susceptible to further trauma.
  • Neurovascular: Dysregulated autonomic nervous system reflexes, and de-sensitized joints receive significantly greater blood flow ⇒ Resultant hyperemia leads to increased osteoclast resorption. This, in addition to mechanical stress, leads to bony destruction.
13
Q

What can Charcot’s foot lead to?

A

Osteomyelitis - Chronic deformation may lead to repetitive trauma of the mid-foot (arch) during walking, leading to ulceration in this area

14
Q

If someone had signs of a septic diabetic foot ulcer, what tests would you do?

A
  • Probe to bone - check for osteomyelitis
  • Swab +/- tissue biopsy
  • Plain X-ray +/- MRI
15
Q

What does being able to “probe to bone” indicate in someone with a diabetic foot ulcer?

A

Route for infection to get into bone

16
Q

What is the first line antibiotic used for diabetic foot ulcer?

A
  • Non-septic - IV fluclox
  • Septic - Tazocin
17
Q

What preventative measures can be taken to attempt to reduce the risk of developing a diabetic foot ulcer?

A
  • Effective patient education
  • Risk factor reduction
  • Regular patient review
18
Q

How would you manage a diabetic foot ulcer?

A
  • Risk factor management
  • Wound care
  • Minimise neuropathy
  • Treat peripheral ischaemia
19
Q
A