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cheapbag214s · Posted: Mon 17:40, 26 Aug 2013 Post subject: The diabetic foot

The diabetic foot,[link widoczny dla zalogowanych]
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,[link widoczny dla zalogowanych], the majority can be cured by immediate and energetic treatment, 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,[link widoczny dla zalogowanych], 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, hot radiators, hot sand on holiday)
Corn plaster
Nail infections (paronychia)
Artefactual (self inflicted foot lesions are rare; occasionally failure to heal is due to this cause)
Heel friction in patients confined to bed
Foot deformities (callus, clawed toes,[link widoczny dla zalogowanych], bunions, pes cavus, hallux rigidus,[link widoczny dla zalogowanych], hammer toe, Charcot's foot, 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), or
Critically ischaemic needing urgent attention,[link widoczny dla zalogowanych].
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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