DIABETIC FOOT CARE

HABIB BAKRI BIN MAMAT

60004049

MEDICAL
ELECTIVES
HOSPITAL SULTANAH NUR ZAHIRAH
(HSNZ)
EMERGENCY DEPARTMENT DR. MOHD LOTFI HAMZAH (HOD OF ED HSNZ)
ORTHOPAEDIC DEPARTMENT DR. HJ. AHMAD TAJUDDIN B. ABDULLAH (SPINE SURGEON OF HSNZ)

OUTLINES
Backgrounds
Approach to a Patient with Diabetic Foot Problems.
Diagnosis and Identification of Risk Factors
Diabetic Foot Ulcers
Diabetic Foot Infections
Diabetic Charcots Foot

TIME principle of wound bed preparation

Prevention
Conclusion

BACKGROUND
The foot manifestation of diabetes is well documented and potentially limb
threatening when left untreated.
A healthy, intact diabetic foot is best maintained by consistent and recurrent
preventive treatment strategy.
Diabetes is chronic problem and the incidence of diabetic foot complications
increases with age and duration of the disease.
Diabetic patients at risk for foot lesions must be educated about the risk
factors and the important of foot care.
The primary management goal for diabetic foot is to heal the ulcer
as early as possible and prevent amputation.
Resolving diabetic foot problems and decreasing the recurrence rate can
lower the probability of lower extremity amputation.

APPROACH TO A PATIENT WITH DIABETIC FOOT

PROBLEMS

DIAGNOSIS AND IDENTIFICATION OF RISK

FACTORS

Diabetic Foot Ulcer

Diabetic Foot Infections
Diabetic Charcots Foot

DIABETIC FOOT ULCER

Lower extremity
assessment
Vascular
Neurological
Musculoskeletal
Ulcer examination
Clinical
Search for osteomyelitis
Cultures & sensitivity
Radiographs

Treatment
Debridement
Wound care
Off loading
Infection treatment
Vascular management
Medical Rx of comorbidities
Surgical management
Reduce risk of recurrence
Prevention

DIABETIC FOOT INFECTIONS

Assessment into
Non- limb threatening
Limb threatening

Treatment
Surgical treatment
Wound care
Antibiotic treatment
Hyperglycemia control
Correct electrolytes
Optimize comorbidities
Frequent reassessment of
response to treatment
If infection subsides but ulcer
persists, follow principles of
diabetic ulcer treatment
Prevention

DIABETIC CHARCOTS FOOT

Assessment
Clinical
Investigations
To exclude osteomyelitis
Treatment
Immobilization and rest
Protected weight bearing
Surgery
Prevention

TIME PRINCIPLE OF WOUND BED

PREPARATION
Tissue non

Infection or

Moisture

Edge of

viable or
defecient

inflammation

imbalance

wound non
advancing or
undermined

Defective
matrix and cell
debris

High bacterial
counts or
prolonged
inflammation

Desiccation or
excess fluid

Non-migrating
keratinocytes
Non-responsive
wound cells

Debridement

Antimicrobials

Dressings
compression

Biological
agents
Adjunct
therapies
Debridement

Restore wound
base and ECM
protein

Low bacterial
counts and
control
inflammation

Restore cell
migration,
maceration
avoided

Stimulate
keratinocyte
migration

PREVENTION
All efforts must be made to prevent foot complications from
occurring in diabetics and this is done through a
multidisciplinary approach.
Aspects of a diabetic foot prevention program include:
Education - patient (daily foot inspection) and physician
(current concepts of foot management)
Foot care - Regular podiatric visits
Therapeutic Shoes - to protect from injury
Reduction of plantar pressure (off-loading) - to reduce
plantar pressure
Surgery - prevention of recurrent ulcers

CONCLUSION
Diabetes Mellitus is a lifelong disease and diabetic foot
complications
can
be
life
threatening,
physically
incapacitating, costly to treat and result in extensive
morbidity.
Screening, proper evaluation, early identification and
treatment of the at risk foot can reduce complications.
A multidisciplinary team approach to diabetic foot problems
can save costs and reduce most foot complications and
amputation rate.
If we manage diabetic foot problems according to this
guidelines, we may attain the objectives of preventing limb
loss, mortality maintain the quality of life of the patient.

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