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Introduction
Diabetes Mellitus (DM) is a common disease worlwide. 15% of patient with DM will develop a lower extremities ulcer during the course of their diseases. Foot complications result from a complex interplay of ischemia, ulceration, infection and diabetic Charcots joint.
Risk Factor
Footwear Poorly fitting shoes. Nerve damage
due to uncontrolled DM, patient will develop peripheral neuropathy.
Poor Circulation
uncontrolled DM acceleration atherosclerosis poor perfusion to injured tissue healing does not occur properly.
Palpation
Left figure: Neuropathy diabetic foot ulcer with callus formation surrounding the ulcer Right figure : Claw toes with high plantar arch
Management
Control of infection -minor foot lesion should be taken seriously and treated early with oral antibiotic -focal cleansing and dressing -if there is any sign of spreading and systemic involvement (ie pyrexia, tachycardia, loss of diabetic control), the pt should be admitted to hospital for further management : Parenteral antibiotics Elevation of the limb Excision of any necrotic tissue and daily dressing
Removal of necrotic tissue -depends on the severity and area of involvement -can be from desloughing of an ulcer to major amputation
Lower limb amputation -indication : Revascularisation is impossible Present of substantial tissue necrosis and a functionally useless foot Present of deep spreading infection
Principles guide the level of amputation 1) The amputation must be made through healthy tissue to prevent risk of wound breakdown and chronic ulceration which will require further amputation at the higher level. 2)The choice of amputation level must take into account the fitting of a prosthetic limb. The mid-tibia(below knee) and lower femoral level(above knee) are preferred. If knee joint can be saves, the functional success of a prosthesis is much better.