DIABETIC FOOT

DIABETES Glycation of the DYSFUNCTION

MELLITUS arterial vessel Absence of skin oils
walls, thickening
of the basement AUTONOMIC Increased
HEMOGLOBIN
membranes, Susceptibility To
AND PROTEINS
and reduced Fissuring
BECOME
GLYCOSYLATED endothelial nitric U
oxide activity. Joint contractures L
Hammertoes, Claw C
SENSORY
PRECIPITATE Multifocal toes and distal E
IN THE WALLS ischemic migration of fat pad R
OF SMALL proximal nerve
PERIPHERAL Loss of protective
lesions and sensation
VESSELS AND
epineural MOTOR
NERVE
vessel
TISSUE
atherosclerosis
Campbell, W., Canale, S., Beaty, J., Daugherty, K., Jones, L., Azar. And Maxey, S. (2017). Campbell’s Operative
Orthopaedics. 13th ed. Philadelphia: Elsevier
 UNIVERSITY OF TEXAS STAGING SYSTEM FOR DIABETIC
FOOT ULCERS
Stage Grade 0 Grade I Grade II Grade III

A Pre and Post Superficial ulcer, not Ulcer penetrating to Ulcer penetrating to
ulcerative lesion involving tendon, tendon or capsule bone or joint
completely capsule, or bone
epithelialized

B Infection Infection Infection Infection

C Ischemia Ischemia Ischemia Ischemia
D Infection and Infection and Ischemia Infection and Ischemia Infection and Ischemia
Ischemia

Armstrong D., Lavery L.A., Harkless, L.B. Validation of a diabetic wound classification system. The contribution of depth, infection, and
ischemia to risk of amputation. Diabetes Care. 1998; 21 (15): 855-859.
DIABETIC FOOT TREATMENT

• Primary goals:
– Healing of the ulcer
– Prevention of secondary infection and recurrence
– Avoidance of amputation
• Treatments:
– Debridement – removal of all hypertrophic callus and nonviable tissue
– Off-loading of affected area
– Patient education
– Total contact casting
OSTEOMYELITIS
OSTEOMYELITIS

inflammation of the bone caused by an infecting organism.

classified based on
DURATION: acute, subacute, or chronic
MODE OF INFECTION: exogenous (i.e. open fractures) or hematogenous (i.e.
bacteremia)
HOST RESPONSE: pyogenic or nonpyogenic
 1. Bacterial seeding in
ACUTE metaphysis
HEMATOGENOUS 2. inflammatory
OSTEOMYELITIS reaction
3. local ischemic
• Most common type of bone necrosis of bone
infection 4. abscess formation
• Age of onset: bimodal, <2 and and enlargement
8-12 years old, male predilection 5. intramedullary
• Most common infecting organism: pressure increases

• Staphylococcus aureus for 6. cortical ischemia

older children and adults 7. purulent material
escape through the
• Pseudomonas for IV drug user
cortex into the
• Salmonella for SS or SC subperiosteal space
hemoglobinopathies. 
 8. subperiostial

 abscess

SUBACUTE
HEMATOGENOUS

OSTEOMYELITIS 


Compared with acute

osteomyelitis, subacute
hematogenous
osteomyelitis has a
more insidious onset
and lacks the severity of
symptoms
A Brodie abscess is a localized form of subacute
osteomyelitis that occurs most often in the long
bones of the lower extremities of young adults. 

CHRONIC
OSTEOMYELITIS
• Hallmark – infected dead bone within a
compromised soft-tissue envelop
• Infected foci within the bone are surrounded by
sclerotic, relatively avascular bone covered by a
thickened periosteum and scarred muscle and
subcutaneous tissue.
SHOULDER TESTS
Speed test
Yergason test
Neer test
Hawkins
KNEE TESTS
REFERENCES:

• Campbell, W., Canale, S., Beaty, J., Daugherty, K., Jones, L., Azar. And Maxey, S.
(2017). Campbell’s Operative Orthopaedics. 13th ed. Philadelphia: Elsevier
• Ednington, J. (2018, November 6). Osteomyelitis - Adult. Retrieved from https://
www.orthobullets.com/trauma/1057/osteomyelitis--adult
• CATHERINE A. CHURGAY, MD, St. Luke's Hospital/The University of Toledo, Family
Medicine Residency Program, Toledo, Ohio, Am Fam Physician. 2009 Sep 1;80(5):
470-476; Diagnosis and Treatment of Biceps Tendinitis and Tendinosis
• Physiotutor (23 June, 2015). Retrieved from https://youtu.be/bXA8cbIZUok