विवरण
This session covers the management of diabetic foot ulcers, including local wound care, the use of mechanical offloading, infection treatment, and indications for revascularization. The assessment of the diabetic foot and the particular care of the endangered limb are examined in isolation. Assessing, evaluating, and classifying the ulcer is the initial stage in addressing diabetic foot ulcers. The clinical assessment of the ulcer's depth and extent, as well as the existence of infection or ischemia, which dictates the kind and degree of treatment, form the basis of classification.
सारांश
- Diabetic foot is a term encompassing serious foot problems in individuals with diabetes, often stemming from minor injuries. Nerve damage (neuropathy), poor blood flow, and a weakened immune system are key contributing factors. Untreated issues can escalate to ulcers, infections, and gangrene, potentially leading to amputation. Early foot care and intervention are essential.
- The pathophysiology of diabetic foot primarily involves nerve and blood vessel damage due to long-term diabetes complications. Peripheral neuropathy causes loss of sensation, allowing injuries to go unnoticed. Motor neuropathy leads to foot deformities, increasing ulcer risk. Autonomic neuropathy results in dry, cracked skin, making it infection-prone.
- Peripheral artery disease (PAD) accelerates atherosclerosis, reducing blood flow to the feet and hindering wound healing. Severely restricted blood flow can lead to tissue death (ischemia), increasing the risk of non-healing ulcers and gangrene. Immune dysfunction, caused by hyperglycemia, impairs white blood cell function, making the body less effective at fighting infections.
- Foot ulcers form due to neuropathy, foot deformities, and improper footwear, leading to excessive pressure and skin breakdown. Poor blood flow and impaired sensation allow ulcers to go unnoticed and untreated, making them prone to infection. Impaired immune response exacerbates infections, making them difficult to control.
- Charcot foot, a severe complication, involves weakened bones in the foot. Neuropathy can mask fractures, leading to further damage and foot deformities, increasing pressure points, ulcers, and infections. Wound healing is impaired due to chronic inflammation, poor blood flow, and dysfunctional fibroblasts, leading to slow healing and increased susceptibility to infection.
- Assessing a diabetic foot involves evaluating foot care practices, including daily inspection, proper footwear, and knowledge of when to seek medical attention. Visual inspection includes examining the skin for dryness, cracks, calluses, blisters, or ulcers, and inspecting toenails for ingrown nails, fungal infections, or deformities.
- Further visual inspection involves looking for foot deformities, such as claw toes or Charcot foot, and checking for swelling or redness, which indicate inflammation or infection. Palpation involves checking pulses in the feet to assess blood flow and checking temperature differences, which can indicate infection or poor circulation.
- A neurological assessment for diabetic foot includes the monofilament test to check for loss of protective sensation, vibration perception using a tuning fork, and pin-prick sensation to test the ability to distinguish between sharp and dull sensations. Ankle reflexes are also checked to identify potential nerve damage.
- Vascular assessment involves measuring the ankle-brachial index (ABI) to assess the severity of peripheral artery disease (PAD). The toe-brachial index (TBI) is used when ABI is falsely elevated. Doppler ultrasound provides a detailed view of blood flow in the arteries of the feet.
- Footwear assessment involves checking the fit and wear of shoes, looking for pressure points that might cause skin breakdown or calluses, and assessing the condition and effectiveness of any orthotics or inserts. Skin and nail hygiene assessment involves evaluating cleanliness, checking for excessive moisture or dryness, and identifying signs of fungal infection.
- The Wagner classification system categorizes diabetic foot ulcers based on severity. Grade 0: Skin intact but bone deformities present. Grade 1: Superficial ulcer limited to the skin. Grade 2: Ulcer extends deeper into the skin, possibly reaching tendons or bones. Grade 3: Ulcer leads to deep abscesses or bone infection. Grade 4: Partial gangrene. Grade 5: Extensive gangrene requiring amputation.
- Evaluation of a diabetic foot ulcer includes measuring its size (length, width, and depth) and assessing its depth (skin, subcutaneous tissues, muscle, or bone). Also, the location of the ulcer is taken into consideration.
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