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The Diabetic FootSyndrome

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The Diabetic FootSyndromeOBJECTIVE:

Describe the risk factors and

pathogenesis of the diabetic footsyndrome, and practice those

strategies known to prevent

amputations.

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Risk Factors For Diabetic FootSyndrome Age > 40

Smoking

Poor glycemic control

Diabetes duration > 10 years

Anatomical changes (bunions,

hammertoes, prominent metatarsalheads

History of prior foot ulcers amputation

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Neuropathy Component

Symptoms

painful dysesthesias

decreased sweating

motor weakness

Signs

decreased sensation of touch, vibration

diminished pulses

muscle atrophy with change in foot shape

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Musculoskeletal Component

Symptoms

gradual change in foot shape

sudden change in shape (Charcotarthropathy of the ankle joint)

Signs

cavus feet with claw toes

rocker bottom foot

prominent metatarsal heads

arthropathy of the ankle joint

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Dermopathy Component

Symptoms

scaling, itching, dryness

slow wound healing

Signs

trophic changes of skin and nails

fungal infections

ingrown nails with paronychia

subungual ulceration or abscess

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Vascular Component Symptoms

cold feet

intermittent claudication

rest pain

Signs

dependent rubor

decreased capillary filling time

vascular bruits

dininished/absent pulses

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Prevention Identify high risk individuals by

history and physical examination

insensate neuropathy (nylonmonofilament)

altered foot shape

prior ulcer or amputation

Teach preventive footcare

Instruct patient to seek healthcareimmediately for foot lesions, infection

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Preventive Footcare Inspect and wash feet daily

Wear shoes and socks at all times

inspect and shake out shoes before wearing

be extra careful with new shoes

Prevent thermal injury

socks for cold weather

do not put foot near heat (stoves, fires,heating pads etc)

test bath water with elbow (not hand or foot)

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Preventive Footcare Callus care: maintain protective callus

do not cut off excess skin

do not use chemical callus treatments soak feet only enough to soften callus for

treatment

use pumice stone or nail file to removeexcess skin

apply lotion/oil daily

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Preventive Footcare

Nail Care

Soak only enough to soften nails for

cutting

Cut straight across to avoid ingrown nails

Leave nails 1/4 to 1/2 inch long (0.5 cm)

Skin Care apply lotion with mineral oil or lanolin

twice daily (avoid between toes)

treat fungal infections

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Ulcer Care Bed rest/non-weight bearing essential

Dry debridement with gauze patch 4times daily

Do not soak ulcers (breaks downprotective barrier)

Antibiotics for infection - parenteralmay be required

May be down to bone with nosymptoms

high risk of osteomyelitis

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Amputations due to thediabetic foot syndromecan be prevented in 50-70% of cases if these

preventive measures arefollowed.