Guardians of Grail

cheapbag214s · Posted: Fri 10:32, 16 Aug 2013 Post subject: The diabetic foot

The diabetic foot
Peter J Watkins
Foot ulceration, sepsis, and amputation are known and feared by almost every person who has diabetes diagnosed. Yet these are potentially the most preventable of all diabetic complications by the simplest techniques of education and care. If lesions do occur, the majority can be cured by immediate and energetic treatment,[link widoczny dla zalogowanych], for which good provision must be made.
Neuropathy and ischaemia are the principal disorders underlying foot problems. Whenever a patient presents with an active lesion, it is essential to decide at an early stage whether the foot problem is:
Precipitating causes of foot ulceration and infection
Friction in ill fitting or new shoes
Untreated callus
Self treated callus
Foot injuries (for example, unnoticed trauma in shoes or when walking barefoot)
Burns (for example, excessively hot bath,[link widoczny dla zalogowanych], hot water bottle,[link widoczny dla zalogowanych], hot radiators,[link widoczny dla zalogowanych], hot sand on holiday)
Corn plaster
Nail infections (paronychia)
Artefactual (self inflicted foot lesions are rare,[link widoczny dla zalogowanych]; occasionally failure to heal is due to this cause)
Heel friction in patients confined to bed
Foot deformities (callus,[link widoczny dla zalogowanych], clawed toes,[link widoczny dla zalogowanych], bunions,[link widoczny dla zalogowanych], pes cavus,[link widoczny dla zalogowanych], hallux rigidus, hammer toe,[link widoczny dla zalogowanych], Charcot's foot,[link widoczny dla zalogowanych], deformities from previous trauma or surgery,[link widoczny dla zalogowanych], nail deformities,[link widoczny dla zalogowanych], oedema)
Neuropathic with an intact circulation
Ischaemic with (usually) or without neuropathy (neuroischaemic foot),[link widoczny dla zalogowanych], or
Critically ischaemic needing urgent attention.
A combination of ulceration and sepsis in an ischaemic foot carries a higher risk of gangrene, and early arterial assessment and management are key to avoiding major amputation.
Men of low socioeconomic class are most prone to diabetic foot disorders, and Asian patients least likely to get them. Many causes are avoidable.
Patients confined to bed must have their heels elevated to avoid heel blisters and sepsis,[link widoczny dla zalogowanych]. Such wounds need weeks or months of treatment and sometimes require …
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