- See:
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Diabetes Menu
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AliMed - diabetic resources
- Pathological Conditions:
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vascular pathology:
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diabetic charcot foot and ankle:
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neuropathic ulceration:
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ankle fractures in diabetics:
- main pitfall is failure to mistake an early charcot ankle fracture for a "simple ankle fracture;"
- failure to consider a charcot ankle fracture may lead to disasterous consequences for the surgeon and patient;
- in the study by McCormack and Leith (JBJS 1998), the authors noted a 42% complication rate in the treatment of diabetic ankle fractures vs no complications
in a match series of ankle frx patients without diabetes;
- of 19 patients treated surgically, 6 developed major complications, and two patients required amputation;
- diabetic patients w/ displaced ankle fractures treated non op showed a high incidence of loss of reduction and malunion but these caused few symptoms;
- the authors recommend strong consideration of non operative treatment in these patients;
- take care to apply generous padding to the cast inorder to avoid pressure ulceration;
- Diabetic Foot Infections:
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management of cellulitis or infected superficial ulcerations:
- see
Wagner grading system for diabetic foot infections:
- non operative treatment is indicated for patients who are not septic;
- ie, no high fever, normal WBC, no altered mentation;
- cultures from ulcers are unreliable (need to treat based on deep cultures obtained from researach studies);
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enterococci may be most common and therefore a logical starting medication would be
augmentin or
unasyn;
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osteomyelitis in the diabetic patient:
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management of deep infections:
- surgical debridement is indicated for all patients who appear acutely toxic;
- be especially careful of the patient with pain/skin changes on both the dorsum and plantar surface of the foot;
- these patients will need both dorsal and plantar incisions for adequate debridement;
- see:
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amputations in the diabetic patient:
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compartmental anatomy of the foot:
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wound dressings
- references:
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Treatment of resistant ulcers on the plantar surface of the great toe in diabetics.
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Management of diabetic midfoot ulcers.
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Diabetic foot infections. Bacteriologic analysis.
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Diabetic Neuropathy:
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cymbalta
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neurontin
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lyrica
The diabetic foot: evolving technologies.
Management of the diabetic foot. Harrelson J: Orthop Clin North Am 1989;20:605.
Simplified two-stage below-knee amputation for unsalvageable diabetic foot infections.
One-stage versus two-stage amputation for wet gangrene of the lower extremity: a randomized study.
Ankle fractures in diabetics. Complications of surgical management. RG McCormack and JM Leith. JBJS. Vol 80-b. No 4. July 1998. p 689. .......
Experience with the vacuum assisted closure negative pressure technique in the treatment of non-healing diabetic and dysvascular wounds.
