The Diabetic Foot Syndrome

The Diabetic Foot Syndrome

OBJECTIVE: Describe the risk factors and pathogenesis of the diabetic foot syndrome, and practice those strategies known to prevent amputations.

Risk Factors For Diabetic Foot Syndrome

Age > 40 Smoking Poor glycemic control Diabetes duration > 10 years Anatomical changes (bunions, hammertoes, prominent metatarsal heads History of prior foot ulcers amputation

Neuropathy Component

Symptoms

painful dysesthesias decreased sweating motor weakness decreased sensation of touch, vibration diminished pulses muscle atrophy with change in foot shape

Signs

Musculoskeletal Component

Symptoms

gradual change in foot shape sudden change in shape (Charcot

arthropathy of the ankle joint)

Signs

cavus feet with claw toes rocker bottom foot prominent metatarsal heads arthropathy of the ankle joint

Dermopathy Component

Symptoms

scaling, itching, dryness slow wound healing trophic changes of skin and nails fungal infections ingrown nails with paronychia subungual ulceration or abscess

Signs

Vascular Component

Symptoms

cold feet intermittent claudication rest pain

dependent rubor decreased capillary filling time vascular bruits dininished/absent pulses

Signs

Prevention

Identify high risk individuals by history and physical examination

insensate neuropathy (nylon

monofilament) altered foot shape prior ulcer or amputation

Teach preventive footcare Instruct patient to seek healthcare immediately for foot lesions, infection

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 socks for cold weather do not put foot near heat (stoves, fires,
heating pads etc) test bath water with elbow (not hand or foot)

Prevent thermal injury

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 remove excess skin apply lotion/oil daily

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

Ulcer Care

Bed rest/non-weight bearing essential Dry debridement with gauze patch 4 times daily Do not soak ulcers (breaks down protective barrier) Antibiotics for infection - parenteral may be required May be down to bone with no symptoms

high risk of osteomyelitis

Amputations due to the diabetic foot syndrome can be prevented in 5070% of cases if these preventive measures are followed.