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The presence of several characteristic diabetic foot pathologies such as infection, diabetic foot ulcer and neuropathic osteoarthropathy is called diabetic foot syndrome.
Pathophysiology
- Diabetic neuropathy (peripheral & autonomic)
- Mechanical disruption
- Vascular insufficiency (Diabetic microangiopathy)
- Impaired tissue healing
Presentation
- Pain, as well as reduced sensations of foot
- Ulceration
- Absence of peripheral pulses
- Notably posterior tibial and dorsalis pedis artery
- Systemic (late) symptoms:
- Ketoacidosis
- Septicaemia
- Myocardial infarction
Wagner-Meggitt Classification of Diabetic foot:
| Grade 0 | Foot symptoms like pain, only |
| Grade 1 | Superficial ulcers |
| Grade 2 | Deep ulcers |
| Grade 3 | Ulcer with bone involvement |
| Grade 4 | Forefoot gangrene |
| Grade 5 | Full foot gangrene |
Diagnosis
Clinical examination:
Blood panel:
- RBS (Random blood sugar)
- Blood urea & serum creatinine
- TLC
- Total Hb
- HbA1c estimation
- Serum albumin
- Nutritional status
Imaging:
- MRI (M/sensitive)
- Doppler/Duplex scan
- MR angiography
Management
Medical management:
Treat underlying cause
- Broad-spectrum antibiotics
- Control of blood sugar
- Blood transfusion (if required)
- High-protein diet (if ↓ serum albumin)
Surgical management:
Foot can be saved only if good blood supply is present
- Debridement of ulcer
- Irrigation of ulcer
- Cleaning of ulcer
Care of feet:
- Avoid injuries
- Feet kept clean & dry
- Microcellular rubber (MCR) footwears