Differentiating Diabetic foot from other diseases: Difference between revisions

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[[Diabetic foot]] must be differentiated from other [[disease|diseases]] that cause [[foot]] [[ulcer|ulceration]], [[erythema]], [[swelling]] and [[skin]] lesion, such as [[skin and soft-tissue infections]], [[gas gangrene]], [[cellulitis]], [[deep venous thrombosis]] and [[Inflammatory disorder|inflammatory disorders]].  
[[Diabetic foot]] must be differentiated from other [[disease|diseases]] that cause [[foot]] [[ulcer|ulceration]], [[erythema]], [[swelling]] and [[skin]] lesion, such as [[skin and soft-tissue infections]], [[gas gangrene]], [[cellulitis]], [[deep venous thrombosis]] and [[Inflammatory disorder|inflammatory disorders]].  
==Differentiating Diabetic foot from other Diseases==
==Differentiating Diabetic foot from other Diseases==
*[[Diabetic foot]] must be differentiated from other [[disease|diseases]] that cause [[foot]] [[ulcer|ulceration]], [[erythema]], [[swelling]] and [[skin]] lesion, such as:<ref name="pmid20859079">{{cite journal| author=Hess CT| title=Checklist for differential diagnosis of lower-extremity ulcers. | journal=Adv Skin Wound Care | year= 2010 | volume= 23 | issue= 10 | pages= 480 | pmid=20859079 | doi=10.1097/01.ASW.0000383230.16279.b0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20859079  }} </ref><ref name="pmid20535310">{{cite journal| author=Pendsey SP| title=Understanding diabetic foot. | journal=Int J Diabetes Dev Ctries | year= 2010 | volume= 30 | issue= 2 | pages= 75-9 | pmid=20535310 | doi=10.4103/0973-3930.62596 | pmc=2878694 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20535310  }} </ref><ref name="pmid30958663">{{cite journal| author=Boulton AJM, Armstrong DG, Kirsner RS, Attinger CE, Lavery LA, Lipsky BA | display-authors=etal| title=Diagnosis and Management of Diabetic Foot Complications | journal= | year= 2018 | volume=  | issue=  | pages=  | pmid=30958663 | doi=10.2337/db20182-1 | pmc= | url= }} </ref>
*[[Diabetic foot]] must be differentiated from other [[disease|diseases]] that cause [[foot]] [[ulcer|ulceration]], [[erythema]], [[swelling]] and [[skin]] lesion, such as:<ref name="pmid20859079">{{cite journal| author=Hess CT| title=Checklist for differential diagnosis of lower-extremity ulcers. | journal=Adv Skin Wound Care | year= 2010 | volume= 23 | issue= 10 | pages= 480 | pmid=20859079 | doi=10.1097/01.ASW.0000383230.16279.b0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20859079  }} </ref><ref name="pmid20535310">{{cite journal| author=Pendsey SP| title=Understanding diabetic foot. | journal=Int J Diabetes Dev Ctries | year= 2010 | volume= 30 | issue= 2 | pages= 75-9 | pmid=20535310 | doi=10.4103/0973-3930.62596 | pmc=2878694 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20535310  }} </ref><ref name="pmid30958663">{{cite journal| author=Boulton AJM, Armstrong DG, Kirsner RS, Attinger CE, Lavery LA, Lipsky BA | display-authors=etal| title=Diagnosis and Management of Diabetic Foot Complications | journal= | year= 2018 | volume=  | issue=  | pages=  | pmid=30958663 | doi=10.2337/db20182-1 | pmc= | url= }} </ref>
**[[Skin and soft-tissue infections]]:
**[[Skin and soft-tissue infections]]:
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***[[Pyoderma gangrenosum]]
***[[Pyoderma gangrenosum]]
***[[Necrobiosis lipoidica]]
***[[Necrobiosis lipoidica]]
Below, find a list of differential diagnosis for diabetic foot:
Below, find a list of differential diagnosis for diabetic foot:
{| class="wikitable"
{| class="wikitable"
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!Scrotal swelling
!Scrotal swelling
!Symptoms of primary disease
!Symptoms of primary disease
|-
|Diabetic foot
|
|
|
|
|
|
|
|
|
|-
|-
|(Cellulitis-[[Erysipelas|erysipelas-]][[skin abscess]])
|(Cellulitis-[[Erysipelas|erysipelas-]][[skin abscess]])
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==References==
==References==
{{reflist|2}}
{{reflist|2}}


[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Endocrinology]]
[[Category:Endocrinology]]

Revision as of 19:47, 29 July 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]

Overview

Diabetic foot must be differentiated from other diseases that cause foot ulceration, erythema, swelling and skin lesion, such as skin and soft-tissue infections, gas gangrene, cellulitis, deep venous thrombosis and inflammatory disorders.

Differentiating Diabetic foot from other Diseases

Below, find a list of differential diagnosis for diabetic foot:

Diseases Symptoms Signs Gold standard Investigation to diagnose
History Onset Pain Fever Laterality Scrotal swelling Symptoms of primary disease
Diabetic foot
(Cellulitis-erysipelas-skin abscess) Acute + + Unilateral - -
  • Usually it doesn't need any laboratory tests to diagnose.[5]
  • Blood cultures are warranted for patients in the following circumstances:[6]
  1. Systemic toxicity
  2. Extensive skin or soft tissue involvement
  3. Underlying comorbidities
  4. persistent cellulitis
Lymphatic filariasis
  • History of living in endemic area or travelling to it
 Chronic + + Bilateral + -

Preparing blood smears

  • Thick smears
  1. Thick smears consist of a thick layer of dehemoglobinized (lysed) red blood cells (RBCs).
  2. Thick smears allow a more efficient detection of parasites (increased sensitivity).
  • Thin smears consist of blood spread in a layer such that the thickness decrease.

By the ultrasound, the following findings can be observed:

  • Dilated lymphatic channels
  • Living worms tend to be in motion which called "filarial dance" sign.
Chronic venous insufficiency Chronic + - Bilateral +

(If congenial)

-
  • Typical varicose veins
  • Skin change distribution correlate with varicose veins sites in the medial side of ankle and leg
  • Reduction of swelling with limb elevation.
Acute deep venous thrombosis Acute + - Unilateral - May be associated with primary disease mandates recumbency for long duration
Lipedema Chronic + - Bilateral - -
  • Tender with palpation
  • Negative Semmer sign to differentiate from lymphedema.[10]
  • Pinching the skin on the upper surface of the toes. If it is possible to grasp a thin fold of tissue then it is negative result.
  • In a positive result, it is only possible to grasp a lump of tissue.
  • MRI offers strong qualitative and quantitative parameters in the diagnosis of lipedema [11]
Myxedema Chronic + - Bilateral - +

(hypothyroidism )

Other causes of generalized edema
  • History of chronic general condition (cardiac-liver-renal)
 Chronic - - Bilateral - +
  • According to the primary cause ( Echo- LFTs- RFT)

References

  1. ↑ Hess CT (2010). "Checklist for differential diagnosis of lower-extremity ulcers". Adv Skin Wound Care. 23 (10): 480. doi:10.1097/01.ASW.0000383230.16279.b0. PMID 20859079.
  2. ↑ 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.
  3. ↑ Boulton AJM, Armstrong DG, Kirsner RS, Attinger CE, Lavery LA, Lipsky BA; et al. (2018). "Diagnosis and Management of Diabetic Foot Complications". doi:10.2337/db20182-1. PMID 30958663.
  4. ↑ Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America". Clin Infect Dis. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.
  5. ↑ Raff AB, Kroshinsky D (2016). "Cellulitis: A Review". JAMA. 316 (3): 325–37. doi:10.1001/jama.2016.8825. PMID 27434444.
  6. ↑ Woo PC, Lum PN, Wong SS, Cheng VC, Yuen KY (2000). "Cellulitis complicating lymphoedema". Eur J Clin Microbiol Infect Dis. 19 (4): 294–7. PMID 10834819.
  7. ↑ Leppard BJ, Seal DV, Colman G, Hallas G (1985). "The value of bacteriology and serology in the diagnosis of cellulitis and erysipelas". Br J Dermatol. 112 (5): 559–67. PMID 4005155.
  8. ↑ Goodacre S, Sutton AJ, Sampson FC (2005). "Meta-analysis: The value of clinical assessment in the diagnosis of deep venous thrombosis". Ann Intern Med. 143 (2): 129–39. PMID 16027455. Review in: ACP J Club. 2006 Mar-Apr;144(2):46-7 Review in: Evid Based Med. 2006 Apr;11(2):56
  9. ↑ Child AH, Gordon KD, Sharpe P, Brice G, Ostergaard P, Jeffery S; et al. (2010). "Lipedema: an inherited condition". Am J Med Genet A. 152A (4): 970–6. doi:10.1002/ajmg.a.33313. PMID 20358611.
  10. ↑ Trayes KP, Studdiford JS, Pickle S, Tully AS (2013). "Edema: diagnosis and management". Am Fam Physician. 88 (2): 102–10. PMID 23939641.
  11. ↑ Dimakakos PB, Stefanopoulos T, Antoniades P, Antoniou A, Gouliamos A, Rizos D (1997). "MRI and ultrasonographic findings in the investigation of lymphedema and lipedema". Int Surg. 82 (4): 411–6. PMID 9412843.
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