Introduction
The world is facing a major epidemic of diabetes
mellitus (DM). There are an estimated 171 million
diabetic patients worldwide and this number is
expected to double by the year 2030. All of these
patients are at risk for developing a diabetic foot ulcer
(DFU). A DFU is any full-thickness wound below the
ankle in a diabetic patient, irrespective of duration.
Once the protective layer of skin is broken, deep
tissues are exposed to bacterial infection that
progresses rapidly. Patients with DFUs frequently
require amputations of the lower limbs and, in more
than half the cases, infection is the preponderant
factor.
Pathophysiology
Pathophysiology
Pathophysiology
Pathophysiology
Pathophysiology
RISK FACTORS
Ulcer Classification
Ulcer Classification
Ulcer Classification
Clinical presentation
About 50% of patients with foot ulcers
due to DM present clinical signs of
infection. By definition, infection is
characterized by the presence of
purulent secretions or at least two of
the classic signs of inflammation
(erythema, hyperemia, edema, or
swelling and pain) but these data can
be masked by lack of the sensitivity in
the patient due to sensory neuropathy
or impaired immune response.
Diagnosis
History and physical examination
A proper investigation should be carried out in all
patientswith diabetes. A good history should include the
duration of DM, neuropathic and peripheral vascular
disease symptoms, previous ulcers or amputations and any
other complication of DM like retinopathy or nephropathy
Examination of ulcer
The location, size, shape, depth, base and margins of the
ulcer should be examined clinically.
Neurological testing
Laboratory investigations
The standard procedure involves measuring blood glucose
level and urine for glucose and ketones. Other
investigations like full blood count, blood urea, electrolytes,
and creatinine levels should be monitored regularly
Imaging
In case of diabetic foot, it is hard to assess
the depth of the ulcer especially when there
is pus and slough covering it. Also, it is hard
to determine the extent of deep infection as
the rubor of inflammatory response is
minimal in subfascial sepsis. X rays are
helpful to determine the depth of foot
ulceration and to assess presence of bone
infection or neuroarthropathy. Radiographs
may reveal bony erosions, fractures,
subluxation/dislocation of multiple joints,
osteosclerotic features or united fractures
Treatment
Conclusion
DM is a global epidemic and the diabetic foot is one
of its most frequent and serious complications,
resulting in high social and economic costs.
According to the International Working Group on the
Diabetic Foot, a leg is lost to DM somewhere in the
world every 30 seconds, with infection accounting
for 50% of these cases.
The five-year mortality rate for diabetes-related
wounds and amputations is 68%, only surpassed by
lung and pancreatic cancer mortality rates 101. We
hope this hospital-based framework for diagnosing
and treating DFIs will help improve the hospital
management of DFIs and ultimately the prognosis of
these patients.