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Vascular Effects of the Diabetic Foot (Viva (Diabetic Foot Syndrome…
Vascular Effects of the Diabetic Foot
Viva
Hx
Control
Complications
Claudication
Previous operations
Other vascular disease
Other vascular risk factors
Diabetic Foot Syndrome
Microvascular disease
Macrovascular disease
Predominantly below knee cf. non-DM occlusive disease.
Neuropathy
Infection and osteomyelitis
Aetiology of Diabetic Ulcers
Neuropathic: 45-60%
Ischaemic: 10%
Mixed neuroischaemic: 25-45%
Preservation of Pulses
Calcification in the walls of the vessels: mediasclerosis
Preserves the pulses until late
→ abnormally high ABPI
Use toe pressure instead: <30mmHg
Similar effect is seen in CRF
Problems w/ Diabetics Undergoing Angiography
Often have a degree of renal impairment which can be dramatically worsened w/ contrast agents.
Metformin must be stopped prior to the procedure to prevent lactic acidosis
Examination
Inspection
Bilateral signs of chronic arterial disease
Amputations: esp. digits
Charcot joints
Ulceration
Palpation
Pulses may be preserved due to calcification
↓ sensation in stocking distribution
Completion
Examine the peripheral nervous system
Urinalysis: proteinuria
Fundoscopy: retinopathy