Diabetic foot and peripheral vascular diseases of the foot足部糖尿病足及周围血管病变.pptVIP

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Diabetic foot and peripheral vascular diseases of the foot足部糖尿病足及周围血管病变.ppt

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* Severe hammer and claw-toe deformities. There are areas of persistent erythema on the dorsum of the fourth and fifth toes. The consequences of the ill-fitting shoe gear have now progressed to marked callus formation at the peak of the hammer toe deformities on the dorsum of the second and third toes. * Diabetic motor neuropathy has resulted in hammer and claw-toe deformities and very prominent metatarsal heads on the plantar surface of the foot. Excessive pressure on the metatarsal heads and inadequate shoe gear have resulted in marked callus build-up that is further accelerated by the dry skin. The patient is at high risk for ulceration at these sites. Ted: Can we remove background and put neutral color or blue background instead so foot shows up better? * This patient has a pes cavus or high plantar arch deformity that has resulted in pressure points and callus formation over the heels, metatarsal heads, and along the medial aspect of the great toe. Extensive callus increases the subcutaneous pressure immediately beneath the callus and can result in a subcutaneous hemorrhage, the so-called “pre-ulcer.” Note the extensive nail pathology. Ted: Can you provide a color background? Wagner grade 2 Wagner grade 3 Wagner grade 4 Wagner grade 5 University of Texas grading Based on wound ulcer depth and vascular status Horizontal component: Stage A – clean wounds Stage B – non-ischemic infected Stage C – ischemic non-infected Stage D – ischemic, infected Vertical component: Grade 0 – pre- or postulcerative site that has healed Grade 1 – superficial wound not involving tendon, capsule or bone Grade 2 – wound penetrating to tendon or capsule Grade 3 – wound penetrating bone or joint Laboratory evaluation FBS/RBS Glycosylated hemoglobin (HbA1C) FHG + ESR Wound and Blood cultures Serum Chemistry: CRP Urinalysis Imaging Plain X-rays - Osteomyelitis, fractures - Soft tissue gas - Dislocations in neuropathic arthropathy CT Scan Technetium bone scans - ost