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DIABETIC ULCER

dr. MULYONI POLAPA, SpB

2018
DIABETIC ULCER

DEFINITION
Infection, ulceration or destruction of deep tissues
associated with neurological abnormalities & various
degrees of peripheral vascular diseases in the lower limb

(based on WHO definition)

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FACTORS ASSOCIATED WITH FOOT
ULCER

 PREVIOUS ULCER/AMPUTATION
 NEUROPATHY : Sensorimotor
 TRAUMA : Poor Footwear
Walking barefoot
Falls/Accidents
Objects inside shoes
 BIOMECHANICS : Limited joint mobility
Bony prominences
Foot deformity/osteoarthropathy
Callus
 PERIPHERAL VASCULAR DISEASE
 SOSIO ECONOMIC STATUS : Low social position
Poor acces to healthcare
Non compliance/neglect
Poor Education
PAT H O P H S I O L O G Y O F
F O O T U L C E R AT I O N

Neuropathic
Ischemic
Neuro -ischemic
ASSESSMENT OF DIABETIC ULCER

Neuropathy
Ischemia
Deformity
Callus
Swelling
Skin breakdown
Infection
Necrosis
STAGES OF ULCER DEVELOPMENT
STAGES OF ULCER DEVELOPMENT
D I A B E T I C N E U R O PAT H Y

Sensorimotor & peripheral sympathatic neuropathy are major risk


factors for ulcer

History & careful foot examination are mandatory to diagnose


neuropathy

Up to 50% of type 2 diabetic patient have significant neuropathy &


at risk of foot ulcer
P E R I P H R A L VA S C U L A R D I S E A S E &
DIABETIC PVD

 PVD is the most important factors related to outcome of


diabetic foot ulcer
 PVD is diagnosed by simple clinical examination
 Non invasive vascular test determines probability of healing
 Symptoms of ischemia may be masked by neuropathy
 Microangiopathy shouldn't be accepted as primary cause of
ulcer
 Conservative approach for treatment
 Outcome of revascularization is similar to that in non-
diabetic
DIABETIC FOOT INFECTION

Infection in diabetic foot is limb threatening

Signs of infection may be absent in diabetic pt. with foot ulcer

Superficial infection is usually caused by gram +ve cocci, deep


infection is poly microbial

Surgical debridment is essential in acute deep infection

Osteomylitis( diagnoses & treatment)


N E U R O O S T E O A RT H R O PAT H Y

 Non- infective pathology


 Should be suspected in any swollen hot erythematous
foot
 Differentiation from infection is important to prevent
misdiagnosis & possible amputation
 Treatment should aim at preventing severe deformity
N E U R O - O S T E O A RT H R O PAT H Y
( C H A R C O T F O O T )
DIABETIC FOOT ULCER
T R E AT M E N T

 Multidisciplenary approach
 Staging dictate the treatment option
 Continuity of care & life long observation
DIABETIC FOOT ULCER
T R E AT M E N T
M O D A L I T I E S

 Metabolic control
 Microbiological control
 Wound control
 Vascular control
 Mechanical control
 Educational control
 Nutritional control
A M P U TAT I O N I N D I A B E T I C PAT I E N T

 Increased minor\major amputation increased the no. of


deformed feet
 Minor amputation is needed :
*Gangrene
*As part of debriment
*for correction of foot deformities
 Minor amputation doesn’t significantly compromise walking
ability
M A J O R A M P U TAT I O N

Risk of loss walking ability


Mortality
Risk of contra-lateral amputation
Strict indication
Careful choice of the level
Contact Us!
RUDIS RS TANI DAN NELAYAN

Yoni Mulyoni

yonimulyoni@yahoo.com 08121129991

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Thank You
Any Questions?