Diabetic Foot Ulcer
Problem Diabetic foot ulcer (DFU) is not only a patient problem but also a major health care concern throughout the world. Diabetic foot ulcer is one of the common and serious complications in diabetic patients.
Factors The most common contributing factors in creating DFU are neuropathy, peripheral artery disease (PAD), deformity and minor trauma.[9] The additional contributing factors are necrosis, gangrene, infection, PAD, advanced age of the patient and other co morbidities such as end stage renal disease (ESRD), and heart failure.[10]
Causes Persistent walking on the affected foot, which is insensitive to pressure sense, alters the healing process.
Pressure • Look for pressure effect on different surfaces of the patient's feet. Pain • The decrease in pain and tenderness is due to neuropathy and the warmth and redness diminishes significantly because of ischemia. Toe Area: • The lateral engorgement of the shoes is an indication of pressure exerted by the first and fifth metatarsals and the swelling observed in the frontal part of the shoes is caused by the pressure of distal phalanges of the first digit. Other body areas: • Diabetic patients due to autonomic neuropathy present with increased perspiration in the upper thorax and lower extremity, perspiration decreases. ANNUAL COMPREHENSIVE FOOT EXAMINATION The physical examination contains observation, palpation of the pulses in the lower extremities, including the posterior tibial and dorsalis pedis pulses. The physical examination also includes neurological tests. At least two neurologic tests are performed: • Measure the protective sensation in which a 10 g monofilament is used.
• Vibration sensation using a 128 Hz diapason, Pinprick sensation, ankle reflex and position are other neurologic test performed in comprehensive foot exam.[12] In patients with neuro ischemic ulcer, unfortunately, the classic signs of infection such as pain, warmth and tenderness are masked.
Patients’ training plays an important role in prevention of DFU. The goal of training is to motivate the patient, and create adequate skills in order to maximize the use of preventive methods.
As a result, the dryness of the plantar surfaces of the feet and heels is common. The minor trauma combined with the dry skin creates cracks which facilitate the entrance of microorganisms into the skin and consequently foot infection is inevitable
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3634178/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435557/
https://emedicine.medscape.com/article/1170337-workup
https://www.ipfh.org/foot-conditions/foot-conditions-a-z/neuropathy-numbness
