Cheatography
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Stages of the Diabetic foot with management plans.
This is a draft cheat sheet. It is a work in progress and is not finished yet.
Stage 1: The Normal Foot
Presentation and Diagnosis: |
Mechanical Control: |
Metabolic Control: |
Educational Control: |
NO risk factors for ulceration- no neuropathy or ischemia, no deformity or callus and no swelling |
Proper footwear in and outside the home |
Blood glucose management |
Encourage healthy foot habits |
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Treat nail pathologies, tinea pedis, dry skin, warts, blisters, chilblains, any skin/nail infections, hyperhydrosis, fissures |
Blood pressure control(goal is 130/80) |
Give footwear advice |
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Quit smoking |
Daily inspection advice |
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Antiplatelet therapy and Lipid control |
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Stage 2: The High Risk Foot
Presentation and Diagnosis: |
Diabetic Foot Classification: |
Mechanical Control: |
Vascular Control: |
Metabolic Control: |
Educational Control: |
When neuropathy or ischemia is present |
W/ Neuropathy: warm with normal pulses, dry skin due to reduced sweating, may have cavoid shape foot, prominent joints with callous |
Footwear- accommodate any deformities |
Perform ABI |
Same as stage 1 |
Same as stage 1 |
Have a deformity, swelling, or callus |
W/ Ischemia: cold with thin, dry atrophic skin, nail and hair growth compromised, absent or reduced pulses, loss of muscle in limb, claudication or rest pain |
Custom insoles |
Inquire about IC and rest pain |
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Prevent trauma- holiday foot care, lifestyle, occupation |
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W/ Neuroischemia: similar to ischemic but relatively pain free |
Footcare- treat callus and dry skin |
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Intrinsic minus foot: denervation of lumbricals, claw toes, high arch, distal migration of fat pad, decreased SA, visible channels b/w mets |
Callus is usually dry in neuropathic foot vs. thin and glassy appearance in the neuroischemic foot (don't debride unless rough) |
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Moisturize- use urea or emollients. Avoid creams and ingredients ending in 'ol or are petroleum based |
Diabetic Renal Foot: When renal impairment develops in the diabetic patient it is accompanied by: peripheral edema, decreased microvascular flow, increase susceptibility to skin breakdown
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Stage 3: The Ulcerated Foot
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