Diabetic Foot

Last Updated on by FRCEM Intermediate

History

  • Previous ulceration
  • Previous amputation
  • Symptoms of neuropathy (numbness, tingling, burning)
  • Symptoms of vascular disease
  • The onset of presenting problem
  • Diabetes control and medication

Examination

Both feet should be examined for

  • Dorsalis pedis pulse
  • Posterior tibial pulse
  • Temperature (cool-ischaemic) warm/hot (?infection)
  • Peripheral sensory neuropathy

Look for

  • Discoloration in the foot, Ulceration, Blisters, Necrosis.
  • Callus with signs of underlying extravasation, capillary leakage.
  • Red areas, Swelling, Infection/Cellulitis, ↑ body temperature, Flu-like symptoms.
  • Poor glycaemic control.
  • Pain in foot or leg even in presence of neuropathy.

Management

  • Thorough wound, vascular, peripheral sensory assessments.
  • Diabetes control and medication
  • Nonadherent dressing to wound (± larger temporary shoe).
  • Broad-spectrum antibiotic in presence of localized infection.
  • Urgent admission for bed rest and i/v antibiotics if spreading cellulitis.
  • X-Ray for osteomyelitis.
  • Refer to multidisciplinary foot care services for multi-professional management

Specialist referral if

  • Limb ischemia- Management of peripheral arterial disease (PAD) – referral to Vascular team?
  • Systemic sepsis/Deep-seated infection control and management – eg. Culture and sensitivity, Antibiotic cover?
  • Debridement and Off-loading necessary * referral to Podiatry*
  • Charcot’s arthropathy (which should be considered if deformity, redness or warmth are present.)
    osteomyelitis is suspected

The multidisciplinary foot care service consists of specialists with skills in the following areas:Diabetology.

  • Podiatry.
  • Diabetes specialist nursing.
  • Vascular surgery.
  • Microbiology.
  • Orthopedic surgery.
  • Biomechanics and orthoses.
  • Interventional radiology.
  • Casting.
  • Wound care

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