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1. How to diagnose diabetic foot ulcers ?

from anamnesis including history of diabetic, daily activities, shoes used, callus formation,
foot deformity, complaints of neuropathy, limb pain during activity or rest, duration of
suffering from DM, comorbid disease, habits (smoking, alcohol), medications being
consumed, history suffered from previous ulcer / amputation. On a physical examination, a
doctor will find the ulcer is a defect in the skin partially or completely (superficial or deep) that is
chronic, infected and can be found pus, necrotic tissue or foreign matter

2. What are the risk factors of diabetic foot ulcer ?


The risk factors include Peripheral vascular disease, Neuropathy, Poor glycemic control,
Cigarette smoking, Diabetic nephropathy, Previous foot ulcerations/amputations. By far,
the two most common risk factors are neuropathy and peripheral vascular disease.

3. Is there any supporting investigation can be done in this case ?


Other tests are transcutaneous oxygen tension (TcP02), ultrasound color Doppler or use a
invasive examination such as; digital subtraction angiography (DSA), magnetic
resonance angiography (MRA) or computed tomography angiography (CTA)

4. What is the differences between tropic ulcer and varicosum ulcer ?


Tropic ulcer is a rapidly developing and painful ulcer, usually in the lower limbs. Several factor
are the existence of trauma, poor hygiene, malnutrition and infection by Bacillus fusiformis. It
usually starts with a small wound, then forms a papule that quickly expands into vesicles. The
vesicles then rupture and small ulcers form.
Varikosum ulcer is an ulcer caused by a disruption of venous blood flow in the lower limbs.
Disorders of venous flow can be caused by abnormalities in the arteries such as venous abnormalities
and damages in the veins proximal to the lower limbs. A sign that is typical of extremities with
chronic venous insufficiency is edema. Ulcers usually have irregular edges, varying size, and can be
broad. At the base of the ulcer, granulation tissue or fibrous material is seen. Can also show a lot of
exudate. The surrounding skin looks brownish red due to hemosiderin.
5. Based on the depth of the wound is there any classification for diabetic foot ulcer ?
We can use classification of diabetic foot ulcer by

Wagner classification for diabetic foot


Stage Foot characteristics
Grade 0 There is no ulceration, but high risk even if there is none
ulcerations , to become diabetic foot. Patients in this group
needs special attention. Periodic observation, maintenance
good feet and counseling is important to prevent ulceration.
Grade 1 Superficial ulcers, without infection, are also called neuropathic
ulcers, by because it is more often found in many leg areas
experience weight pressure which is in the area of the toes and
plantar. Kallus is often seen.
Grade 2 Deep ulcer, accompanied by cellulitis, without abscess or bone
abnormalities the presence of deep ulcers, often accompanied by
infection but without bone abnormalities.
Grade 3 Deep ulcer accompanied by skin abnormalities and extensive deep
abscesses.
Grade 4 Gangrene is limited to only the toes, heel causes the main thing is
ischemia, therefore it is also called the ischemic ulcer limited to
certain areas
Grade 5 Whole leg gangrene usually due to blockage of large arteries, but
there are also disorders of neuropathy and infection
6. What is the clinical manifestation for diabetic foot ulcer ?
Clinical features are distinguished:
 Neuropathic Foot which consists of: Neuropathic Ulcer, Neuropathic arthropathy
(Charcot arthropathy), Neuropathic Edema
 Neuro-ischemic-foot

7. What is the prevention for patient with diabetes to prevent diabetic foot ulcer ?
Diabetics should be taught to inspect their feet regularly and should know how to
recognize a problem with their feet before it becomes a major issue. The following
information should be imparted to diabetic patients and should be repeated regularly:

 Inspect feet daily- if the patient is unable to perform this task themselves, a family
member should be taught how to perform a thorough assessment of foot health.
 Cleanse feet daily and apply a moisturizer to prevent dryness and the formation of
cracks. Dry thoroughly between the toes.
 Diabetic socks or thick padded socks should be worn inside shoes that fit properly and
offer good support- custom shoes should be considered if foot deformity exists.
 Remind patients to avoid hot soaks, harsh chemical agents and heating pads.
 Minor wounds, such as small cuts or scrapes, should be cleansed and treated with a
topical antiseptic- any wound, no matter how minor, that fails to heal quickly should be
inspected by a physician.
 Nails should be trimmed straight across. If the patient cannot manage nail care
themselves, it should be performed routinely by someone trained in the care of diabetic
feet (i.e., a podiatrist)- ingrown toenails should be treated promptly and any signs of
infections should be reported to the physician.

Prevention also includes quitting smoking, maintaining tight glucose control, weight
control and control of blood pressure

8. What management can be done in patients with diabetic foot ulcer?


Debridement, to clean foreign matter and necrotic tissue in the wound. The best type of
debridement is usually done is Surgical debridement.
Reducing Pressure Load (Off Loading) to accelerate ulcer healing
Infection Control, based on the results of germ culture. But before the results of the
culture and sensitivity of the germs available antibiotics must be given empirically to the
infected diabetic foot.
Dressing techniques on diabetic wounds emphasize the moist wound healing method or keep
the wound moist. Wounds will heal quickly if the exudate can be controlled, keeping the wound
moist, the wound not sticky with compresses, avoiding infection and permeable to gas.
9. What is the aim of surgical debridement in patients with diabetic foot ulcer ?
 Evacuate contaminated bacteria,
 Lifting necrotic tissue so that it can speed healing,
 Eliminating callus tissue,
 Reduce the risk of local infection

10. Under what conditions is amputation has to be done in diabetic foot patients?
The action of amputation is carried out when there is gas gangrene, the infected tissue, to
stop the expansion of the infection, remove the part of the foot that has a recurrent ulcer.