Diabetic foot ulcers

Publisher Website
Google Scholar
Abstract
Neuropathic foot ulcer Neuropathic ulcers usually occur on the plantar aspect of the foot under the metatarsal heads or on the plantar aspects of the toes. Left: Neuropathic foot with plantar ulcer surrounded by callus. Right: Ulcer over medial aspect of first metatarsophalangeal joint of neuroischaemic foot Left: Callus removal by sharp debridement. Right: Whitish, macerated, moist tissue under surface of callus, indicating imminent ulceration The most common cause of ulceration is repetitive mechanical forces of gait, which lead to callus, the most important preulcerative lesion in the neuropathic foot. If allowed to become too thick, the callus will press on the soft tissues underneath and cause ulceration. A layer of whitish, macerated, moist tissue found under the surface of the callus indicates that the foot is close to ulceration, and urgent removal of the callus is necessary. If the callus is not removed, inflammatory autolysis and haematomas develop under the callus. This leads to tissue necrosis, resulting in a small cavity filled with serous fluid giving the appearance of a blister under the callus. Removal of the callus reveals an ulcer. Left: Blister under a callus over first metatarsal head. Centre: The roof of the blister is grasped in forceps and cut away, together with associated callus. Right: Ulcer is revealed underneath This is the third in a series of 12 articles A foot ulcer is a sign of systemic disease and should never be regarded as trivial Further reading Edmonds M, Foster AVM, Sanders L . A practical manual of diabetic foot care. Oxford: Blackwell Science, 2004. Bowker JH, Pfeifer MA , eds. Levin and O'Neal's the diabetic foot. 6th ed. St Louis: Mosby, 2001. Boulton AJM, Connor H, Cavanagh PR , eds. The foot in diabetes. 3rd ed. Chichester: Wiley, 2000. The International Working Group on the Diabetic Foot . International consensus on the diabetic foot. 2003 (www.iwgdf.org/concensus/introduction.htm) Veves A, Giurini JM, Logerfo FW , eds. The diabetic foot. Medical and surgical management. Totowa, NJ: Humana Press, 2002. National Institute for Clinical Excellence . Type 2 diabetes. Prevention and management of foot problems. London: NICE, 2004. (www.nice.org.uk/pdf/CG010NICEguideline.pdf)

This publication has 0 references indexed in Scilit: