Diabetic Ulcers

Contributing Factors :

- Mechanical changes in conformation of the bony architecture of the foot

- Peripheral Neuropathy

- Peripheral Arterial Disease

- Glycosilation - Predisposes ligaments to stiffness

Diabetic Facts:

- 12-24% of individuals with ulceration require amputation

- Half of all non-traumatic amputations are the result of diabetic foot complications

- The 5-year risk of needing an amputation on the other extremity is 50%


Diabetic Peripheral Neuropathy results in:

- Loss of sensation in the foot

- Injuries and fractures

- Structural foot deformities

- Hammertoes

- Bunions

- Metatarsal Deformities

- Charcot Foot

- Tissue Breakdown


Peripheral Arterial Insufficiency Results In:

- Intermittent claudication

- Pain at rest

- Non-healing ulceration of the foot

- Ischemia of the foot - Inadequate blood supply

Examination:

Diabetic Ulcers tend to occur in the following areas:

- Heel

- Metatarsal Heads

- The tops and ends of hammertoes


Lab Studies:

- A complete blood count may signal an abscess or infection

- Non invasive vascular studies to assess circulation deficiencies

- Infection markers such as the sedimentation rate


Imaging (to evaluate the presence of osteomyelitis):

- Plain Radiographs

- CT

- MRI

- Bone Scans


Treatments:

- Treat infections with appropriate antibiotics

- Offloading the area of the ulcer

- Wound care

- Application of a Wound Vac - Negative pressure under an occlusive wound dressing for deep cavity wounds

- Surgical Debridement - Surgical management is indicated for debridement of non viable and infected tissue from the ulceration

- Debridement of infected bone