Diabetic foot resident survival guide: Difference between revisions
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{{familytree | | | | A01 | |A01=<div style="float: left; text-align: left; line-height: 150% ">'''Prophylactic measures and Diabetic foot care in all patients''' <br> ❑ Glycemic control <br>❑ Apporpriate footwear and podiatric care <br> ❑ Mechanical offloading | {{familytree | | | | A01 | |A01=<div style="float: left; text-align: left; line-height: 150% ">'''Prophylactic measures and Diabetic foot care in all patients''' <br> ❑ Glycemic control <br>❑ Apporpriate footwear and podiatric care <br> ❑ Mechanical offloading <br> • Cast Walkers <br> • Total contact casting <br> • Therapeutic shoes <br< ❑ Vascular care to prevent and treat peripheral arterial disease <br> | ||
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'''Obtain a detailed history:''' <br> ❑ Onset of diabetes <br> ❑ Duration of diabetes <br> ❑ Compliance with medication <br> ❑ History of glycemic control <br> ❑ History of other diabetic complcatios <br> ❑ Foot deformities/injuries/ulcers <br> ❑ History of lower limb amputation <br> ❑ Type of footwear <br> ❑ Foot hygiene <br> ❑ History of claudication <br> ❑ Smoking history <br> </div>}} | |||
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Revision as of 01:55, 11 August 2020
| Resident Survival Guide |
|---|
| Introduction |
| Team |
| Guide |
| Page Template |
| Examine the Patient Template |
| Navigation Bar Template |
| Checklist |
| Topics |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ifrah Fatima, M.B.B.S[2]
Overview
This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated. Diabetic foot superseded with the following may result in sepsis and death. [1]
- Infected diabetic foot
- Osteomyelitis
Common Causes
- Poor glycemic control
- Peripheral neuropathy
- Peripheral arterial disease
- Peripheral ischemia
- Improper footwear
- Foot deformities including Charcot arthropathy [1] [2] [3]
Diagnosis
Assessment of diabetic foot includes evaluation of peripheral arterial disease, peripheral neuropathy, and foot deformities. Shown below is an algorithm summarizing the diagnosis of diabetic foot and diabetic foot ulcers according to the recommendations of the American Diabetes Association [4] [5] and International Diabetes Federation- Clinical Practice Recommendations on the Diabetic Foot 2017. "Guidelines".
Characterize the symptoms: ❑ Onset ❑ Type of sensation ❑ Location ❑ Nocturnal variation ❑ Aggravating factors ❑ Relieving factors Obtain a detailed history: ❑ Onset of diabetes ❑ Duration of diabetes ❑ Compliance with medication ❑ History of glycemic control ❑ History of other diabetic complcatios ❑ Foot deformities/injuries/ulcers ❑ History of lower limb amputation ❑ Type of footwear ❑ Foot hygiene ❑ History of claudication ❑ Smoking history | |||||||||||||
Examine the patient: Inspection ❑ Location of ulcer ❑ Integrity and charcteristic (dry/cracked) of skin ❑ Sweating Palpation ❑ Pedal (dorsalis pedis) pulses ❑ Vibration sensation ❑ Ulcer site- warmth, tenderness, edema Non-invasive tests ❑ Semmes-Weinstein monofilament test ❑ Probe-to-bone test if suspected osteomyelitis ❑ Measure ABI (Ankle-Brachial Index) with a Arterial doppler | |||||||||||||
Order tests: ❑ Glycosylated hemoglobin/ HbA1c ❑ Fasting plasma glucose ❑ Complete blood count ❑ ESR and CRP ❑ Deep tissue specimen for culture | |||||||||||||
Treatment
Assessment of diabetic foot includes evaluation of peripheral arterial disease, peripheral neuropathy, and foot deformities. Shown below is an algorithm summarizing the diagnosis of diabetic foot and diabetic foot ulcers according to the recommendations of the American Diabetes Association [4] [5] and International Diabetes Federation- Clinical Practice Recommendations on the Diabetic Foot 2017. "Guidelines".
Prophylactic measures and Diabetic foot care in all patients ❑ Glycemic control ❑ Apporpriate footwear and podiatric care ❑ Mechanical offloading • Cast Walkers • Total contact casting • Therapeutic shoes <br< ❑ Vascular care to prevent and treat peripheral arterial disease Obtain a detailed history: ❑ Onset of diabetes ❑ Duration of diabetes ❑ Compliance with medication ❑ History of glycemic control ❑ History of other diabetic complcatios ❑ Foot deformities/injuries/ulcers ❑ History of lower limb amputation ❑ Type of footwear ❑ Foot hygiene ❑ History of claudication ❑ Smoking history | |||||||||||||
Do's
- The content in this section is in bullet points.
Don'ts
- The content in this section is in bullet points.
References
- ↑ 1.0 1.1 Pendsey SP (2010). "Understanding diabetic foot". Int J Diabetes Dev Ctries. 30 (2): 75–9. doi:10.4103/0973-3930.62596. PMC 2878694. PMID 20535310.
- ↑ Mishra SC, Chhatbar KC, Kashikar A, Mehndiratta A (2017). "Diabetic foot". BMJ. 359: j5064. doi:10.1136/bmj.j5064. PMC 5688746. PMID 29146579.
- ↑ Rathur HM, Boulton AJ (2007). "The diabetic foot". Clin Dermatol. 25 (1): 109–20. doi:10.1016/j.clindermatol.2006.09.015. PMID 17276208.
- ↑ 4.0 4.1 Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA; et al. (2017). "Diabetic Neuropathy: A Position Statement by the American Diabetes Association". Diabetes Care. 40 (1): 136–154. doi:10.2337/dc16-2042. PMC 6977405 Check
|pmc=value (help). PMID 27999003. - ↑ 5.0 5.1 American Diabetes Association (2020). "11. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes-2020". Diabetes Care. 43 (Suppl 1): S135–S151. doi:10.2337/dc20-S011. PMID 31862754.