The Diabetic Foot
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Introduction
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Complications in the diabetic foot is mostly caused by a triad of ischemia, Diabetic Neuropathy, and infection. [1]
Statistics about the impact of diabetic foot complications:[1]
- Foot ulcer complications are the main reason why people with diabetes are hospitalized and have to undergo amputations.
- 20-40% of all the health care costs comprised for diabetes are for diabetic foot complications
- 7-10% of patients with diabetes and neuropathy will develop an ulcer; this increases up to 30% for patients with diabetes and other comorbidities.
- 5-8% of patients will undergo a major amputation 1 year after developing a diabetic ulcer.
- A foot ulcer preceded 85% of diabetes related amputations.
- “Diabetes increases the risk of amputation 8-fold in patients aged >45 years,8 12-fold in patients aged>65 years and 23-fold in those aged 65––74 years.”
More information on Diabetes is available from these Physiopedia pages: DM Type 2 and DM Type 1, Diabetes
Specific Foot Conditions
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Diabetic Foot Ulcers and Delayed Wound Healing
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The risk of developing Peripheral Arterial Disease is increased with diabetes and ischemia is considered the biggest culprit delaying wound healing.[1]
Diabetes Mellitus and Diabetic Ulcers
Diabetic Foot Infections
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Infections in a diabetic foot can rapidly spread to the rest of the body and if not treated properly could lead to a life-threatening general septic infection.[1]
Diabetic Neuropathy
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Diabetic Foot (Charcot foot/joint)[edit | edit source]
Also known as Charcot-Marie-Tooth Disease or Diabetic foot arthropathy.
More information available from Charcot-Marie-Tooth Disease - NHS Choices (2012).
Clinically Relevant Anatomy
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Mechanism of Injury / Pathological Process
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Clinical Presentation[edit | edit source]
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Assessment[edit | edit source]
Diabetic foot/stump assessment form
Outcome Measures[edit | edit source]
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Management / Interventions
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Physical Therapy
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- Physical Therapists are involved in both the prevention and management of diabetic foot complications. [3] This is done by gait, posture, and foot off-loading education and training.[3]
- Management of painful diabetic neuropathy:
- In a 2009 evidence-based literature review, the authors found that TENS might be effective for pain treatment in diabetic neuropathy.[4]
- In a 2009 evidence-based literature review, the authors found that TENS might be effective for pain treatment in diabetic neuropathy.[4]
- Diabetes Medical and Physical Therapy Management
- Charcot Foot Medical Management
- Charcot Foot Physical Therapy Managment
- Charcot Foot Medical and Physical Therapy Management
- Diabetic Neuropathy Management/Intervention
- The Physical Therapist is also involved in the rehabilitation process after an amputation.
Medical Management
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- Diabetic foot infection
- Antibiotic treatment is indicated in all infected wounds in combination with wound care, until the infection is cleared up.[1]
- Hospitilisation, immobilisation, and IV antibiotics are indicated for limb threatening or uncontrolled infections.[1]
- Urgent surgery is indicated if the infection is "accompanied by a deep abscess, extensive bone or joint involvement, crepitus,
substantial necrosis or gangrene, or necrotising fasciitis."[1] Lepäntaloa et al. recommend that "surgical intervention for moderate or severe infections is likely to decrease the risk of major amputation."[1]
- Antibiotic treatment is indicated in all infected wounds in combination with wound care, until the infection is cleared up.[1]
Differential Diagnosis
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Key Evidence[edit | edit source]
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Resources
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Case Studies[edit | edit source]
- Amputation secondary to Diabetes Mellitus: Amputee Case Study
- A 35 year old diabetic Aboriginal women, who underwent a right transtibial amputation for diabetic foot ulcer and completed prosthetic rehabilitation.
- Diabetic patient amputation: Amputee Case Study
- Diabetic complications leading to amputation: Amputee Case Report
- Diabetic Patient with Bilateral Amputations : Amputee Case Study
- The Young, Diabetic Amputee: Amputee Case Study
- Bilateral Below Knee Amputation due to Diabetic Complications: Amputee Case Study
- Lower Limb Amputation: Diabetic Case Presentation: Amputee Case Study
- Older Diabetic Amputee with slow healing: Amputee Case Study
- A case study of a diabetic elderly amputee patient
Follow this link to read more case studies.
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Lepäntaloa M, Apelqvistc J, Setaccie C, Riccof JB, de Donatoe G, Beckerg F, Robert-Ebadig H, Caoh P, Ecksteini HH, De Rangok P, Diehml N. Chapter V: Diabetic Foot. European Journal of Vascular and Endovascular Surgery. 2011;42(S2):S60-74. http://www.angiologiaparaclinicos.com/wp-content/uploads/2013/10/Chapter-V-Diabetic-Foot.pdf (Accessed March 2017)
- ↑ Youtube Video: The Diabetic Foot Exam https://youtu.be/aVz-Ja9Grvg
- ↑ 3.0 3.1 Kalra S, Kalra B, Kumar N. Prevention and management of diabetes: the role of the physiotherapist. Diabetes Voice. 2007;52 (3) https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjOw_PQkuvSAhXCJCYKHV_3DZkQFgghMAA&url=https%3A%2F%2Fwww.idf.org%2Fsites%2Fdefault%2Ffiles%2Fattachments%2Farticle_522_en.pdf&usg=AFQjCNF94y1s0ROyDphQwPkZIpo4F0Jeeg&sig2=eTOGhpZ_hHxZqIMTJEqCiQ (Accessed 22 March 2017)
- ↑ Dubinsky RM, Miyasaki J. Assessment: Efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review) Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2010 Jan 12;74(2):173-6. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjB0LrwlOvSAhUJRyYKHQHKBNYQFggcMAA&url=https%3A%2F%2Fwww.aan.com%2FPressRoom%2FHome%2FGetDigitalAsset%2F8478&usg=AFQjCNG9I0tj3VkkBttcIwjXfJmZ77rgUg&sig2=d-z_DivD6wzIHMaD-lxTlw (Accessed 22 March 2017)
