Description
A case discussion on Diabetic Foot typically involves a comprehensive analysis of a patient’s clinical presentation, history of diabetes management, and potential risk factors for foot complications. It delves into the assessment of neuropathy, vascular supply, and infection status of the foot, while considering various differential diagnoses. The discussion also focuses on the importance of glycemic control, appropriate footwear, regular foot inspections, and multidisciplinary approaches for treatment. This includes decisions about debridement, antibiotic therapy, and, in severe cases, the possibility of amputation. The case would also address patient education on foot care to prevent recurrence and the role of regular monitoring to mitigate future risks.
Résumé
- The definition of a diabetic foot, according to WHO, involves infection, ulceration, or destruction of deep tissues, accompanied by neurological abnormalities and varying degrees of peripheral artery disease in the lower limbs. This condition accounts for 40-60% of all non-traumatic lower limb amputations, with 85% of diabetic foot-related amputations preceded by a foot ulcer.
- Factors associated with foot ulcers include previous ulceration or amputation, neuropathy, trauma, biomechanics, peripheral artery disease, and socioeconomic status. Pathophysiologically, diabetic foot ulcers can be classified as neuropathic, ischemic, or neuro-ischemic, depending on the underlying cause and involvement of nerves and arteries.
- Neuropathy affects motor, sensory, and autonomic nerves. Motor neuropathy affects posture and coordination, while sensory neuropathy causes patients to be unaware of repeated trauma. Autonomic neuropathy leads to decreased sweating, dryness, and fissure formation. Callus formation can increase pressure at a particular point by more than 30%, leading to ulcer development.
- Peripheral vascular disease can mask symptoms of ischemia due to sensory neuropathy. Microangiopathy contributes to decreased blood supply. Peripheral neuropathy, structural foot deformity, ulcerations, infections, and peripheral artery disease are all risk factors for lower extremity amputation.
- Prevention of foot problems involves regular inspection and examination, identification of high-risk patients, educating patients, families, and healthcare providers, and appropriate footwear. Treatment involves a multidisciplinary approach including vascular surgeons, interventional radiologists, podiatric surgeons, plastic surgeons, and clinical psychologists.
- Amputation is an outcome in severe cases. Minor amputations are common but major amputations increase mortality. Prevention involves routine diabetic foot analysis, early identification of at-risk patients, and managing modifiable risk factors such as lifestyle choices and foot care.
Exemple de certificat
À propos des intervenants
Dr Rahul Agarwal
Chirurgien vasculaire et endovasculaire consultant, hôpitaux Evercare
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