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    TROPHIC ulcer ulceration IN the NEUROPATHIC foot develops IN POINTS of INCREASED MECHANICAL PRESSURE on the SOLE and DISTAL END of toes and THEY ARE MORE SEVERE CLINICAL CLASSIFICATION OF DIABETIC FOOT LESIONS GR 0-AT RISK FOOT GR 1-SUPERFICIAL ULCER GR 2-DEEP ULCER,INFECT

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    Management of Trophic Ulcer in a Diabetic

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    TROPHIC ulcer ulceration IN the NEUROPATHIC foot develops IN POINTS of INCREASED MECHANICAL PRESSURE on the SOLE and DISTAL END of toes and THEY ARE MORE SEVERE CLINICAL CLASSIFICATION OF DIABETIC FOOT LESIONS GR 0-AT RISK FOOT GR 1-SUPERFICIAL ULCER GR 2-DEEP ULCER,INFECT

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    866 views22 pages

    Management of Trophic Ulcer in A Diabetic

    Uploaded by

    api-3823785
    TROPHIC ulcer ulceration IN the NEUROPATHIC foot develops IN POINTS of INCREASED MECHANICAL PRESSURE on the SOLE and DISTAL END of toes and THEY ARE MORE SEVERE CLINICAL CLASSIFICATION OF DIABETIC FOOT LESIONS GR 0-AT RISK FOOT GR 1-SUPERFICIAL ULCER GR 2-DEEP ULCER,INFECT

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    of 22

    MANAGEMENT OF

    TROPHIC ULCER
    IN A DIABETIC

    IN PHC SETTING
    DIABETES IS ESSENTIALLY A
    METABOLIC DISORDER CAUSED BY
    LITTLE OR NO ABILITY OF THE
    PANCREAS TO PRODUCE INSULIN
    WHICH LEADS TO CHRONIC
    HYPERGLYCEMIA AND BOTH
    ACUTE- KETOACIDOSIS
    HYPEROSMOLARITY
    CHRONIC- MACROANGIOPATHY
    MICROANGIOPATHY
    NEUROPATHY
    COMPLICATIONS
    DIABETIC FOOT

    PATHOGENESIS:

    20%-NEUROPATHY
    70%-NEUROISCHAEMIC
    10%-ISCHAEMIC
    TROPHIC ULCER
    ULCERATION IN THE
    NEUROPATHIC FOOT DEVELOPS
    IN POINTS OF INCREASED
    MECHANICAL PRESSURE ON THE
    SOLE AND DISTAL END OF TOES

    ISCHAEMIC LESIONS ARE


    USUALLY LOCATED ON FOOT
    SIDES AND TOES AND THEY ARE
    MORE SEVERE
    CLINICAL CLASSIFICATION OF
    DIABETIC FOOT LESIONS
    GR 0-AT RISK FOOT
    GR 1-SUPERFICIAL ULCER
    GR 2-DEEP ULCER,INFECTED,NO
    BONE INVOLVEMENT
    GR 3-DEEP ULCER, ABSCESS, BONE
    INVOLVED
    GR 4-LOCALISED GANGRENE
    GR 5-GANGRENE OF WHOLE FOOT
    Neuropathy, microangiopathy, infection

    spreading ulcer

    cellulitis

    abscess

    gangren

    osteomyelitis

    gangrene

    Septicemia & ketoacidosis


    Risk factors for diabetic foot
    H/O ulceration – perforating plantar
    ulcer
    Intermittent claudicating
    Deformity-callus, claw toes, flat
    foot
    Loss of temp, discrimination, pain
    & vibration(at least 2)
    Evidence of haemodynamically
    significant PVD on investigation
    Evaluation
    CLINICAL:
    Sensory
    Motor
    Autonomic
    INVESTIGATIONS
    CBP
    Blood and urine sugar
    Pus for c/s
    X-ray foot
    ECG, chest x-ray
    Others: LFT, urea, creat. ,electrolytes
    ,LL angio.
    Prevention
    Diabetics not at high risk:

    Foot care, file nails, wear comfortable


    well fitting shoes
    Stop smoking
    Aim for max glycaemic control
    Regular exercise
    Diabetics at high risk:
    Inspect foot daily
    Report any lesion or suspected
    change of colour
    Never walk bare foot
    Wash feet daily….
    Nail care
    Foot wear- MCR
    Do not expose feet to extremes of
    temperature
    Management
    Grade 0 Strict metabolic control- reg. insulin
    Prompt RX of superficial fungal/
    bacterial infections
    TT prophylaxis
    Grade 1 Rest the limb, avoid wt bearing
    Ensure adequate drainage
    Rinse with disinfectant and dry
    dressing( no ointment)
    Grade 2 Broad spectrum antibiotic
    & above Local debridement of necrotic areas /
    I&D
    Frequent dressings
    Management contd..

    Tertiary level:

    Revascularisation procedures if
    significant ischaemia

    Amputation if the above measures


    fail and gangrene develops
    IN OUR RHC
    Control of diabetes:
    sliding scale
    Control of infection:
    Culture and sensitivity, antibiotics
    multiple abscesses :- I & D
    Local treatment of diabetic foot:
    Healing :- cleaning & dressing
    Non- healing :- H2O2/ Ensol/ iodine sol
    Spreading :- debridement
    General management

    Diabetic diet
    Exercise
    Oral hypoglycemic agents
    Causes of death

    Septicemia with ketoacidosis

    Electrolyte abnormalities

    Silent MI
    REFERENCE

    DIABETES- MINIATLAS
    DIABETES FOOT DISEASE
    www.diabetes.usyd.edu.au
    www.diabetes-self-mgmt.com
    DIABETES MELLITUS –
    DR.P.G.RAMAN
    THANK YOU

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