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DIABETIC FOOT (LEG

ULCER)

ISMAIL BASTOMI
ORTHOPAEDIC AND TRUMATOLOGI
MOH. HOESIN HOSPITAL
UNIVERSITAS SRIWIJAYA
INTRODUCTION
 Foot problems are a leading cause of
hospitalization for the eight million persons in
the United States who have been identified
as having diabetes mellitus.

 DECREASED QUALITY OF LIFE

 MULTIDISIPLINER
 UK : 1 % POPULATION IS DIABETIC

 12 % OF DIABETIC ADMISSION ARE


WIYH FOOT PROBLEMS
PATHOGENESIS
PATOLOGI
 NEUROPHATHY
 POOR CIRCULATION
 INFECTION
CLINICAL FEAUTURE
 NEUROPHATHY :
 MOTOR : WEAKNESS OF INTRINSIC
MUSCLE
 SENSORY : PAIN OR LOSS OF
SENSATION
 AUTONOM

ULCER w/wo INFECTION :


 NEUROPHATHY
 ISCHEMI
NERVE FUNCTION
 Nylon monofilaments
(Ø5,07) can be felt 
has protective
sensation
Dopler ultrasound
 ABI (ankle brachial
index)  prediction of
healing
 ABI < 1  vascular
disease
 ABI < 0,6  not
recommended to
reconstruction vascular
 Arteriografi patency and
occlusion of the arteri
 C+R

 WCC + ESR

 Plain X-ray
TABLE 1
Risk Factors for Lower Extremity Amputation in the
Diabetic Foot

• Absence of protective sensation due to


peripheral neuropathy
• Arterial insufficiency
• Foot deformity and callus formation resulting in
focal areas of high pressure
• Autonomic neuropathy causing decreased
sweating and dry, fissured skin
TABLE 1
Risk Factors for Lower Extremity Amputation in the Diabetic
Foot

• Limited joint mobility


• Obesity
• Impaired vision
• Poor glucose control leading to impaired wound
healing
• Poor footwear that causes skin breakdown or
inadequately protects the skin from high pressure
and shear forces
• History of foot ulcer or lower extremity amputation
Clasification
Wagner ulcers clasification
Grade Lesion
0 No open lesions; may have deformity or cellulitis

1 Superficial diabetic ulcer (partial or full thickness)

2 Ulcer extension to ligament, tendon, joint capsule, or deep


fascia without abscess or osteomyelitis
3 Deep ulcer with abscess, osteomyelitis, or joint sepsis

4 Gangrene localized to portion of forefoot or heel

5 Extensive gangrenous involvement of the entire foot


TREATMENT
 PREVENTIVE
 ELIMINATION OF INFECTION
 SURGERY
PREVENTION
PREVENTION
PREVENTION
 CONTROL BS REGULARLY
 DO NOT SMOKING
 INCREASED THE KNOWLEDGE OF
DIABETES
Elimination of infection
 Give AB  sign of infection
 Till the cultur has done
 Removal of bone infection
 Drainage of abscesses
 amputation
Neurophatic ulcer
 Bed rest
 Non wt bearing on crutches
 Total plaster cast
Ischaemic ulcers
 Angioplasty
 amputation
Surgery
 Debridement
 Drainage abscesses
 Removal bone infected
 Revascularisation from ischaemic foot
 Corection or resection of any fixed deformity
 Amputation
Amputation
 Toe amputation
 Ray resection
 Lysfranc amputation
 Symes amputation
 Higher level amputation
Thanks