Diabetic Foot Ulcer Case scenarios .pptx

diabetic foot ulcer case scenarios

1. Diabetic Foot Ulcer Management Case Presentation & Clinical Approach Dr R Ashok Kumar, MCh.,

2. Introduction Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus associated with neuropathy, peripheral arterial disease, and infection Causes significant morbidity, risk of amputation, and reduced quality of life Risk Factors Peripheral neuropathy Peripheral vascular disease Poor glycemic control Foot deformities Previous ulcer or amputation Poor footwear and trauma

3. Classification Systems Wagner Classification University of Texas (UT) Classification PEDIS system (Perfusion, Extent, Depth, Infection, Sensation)

4. Evaluation and Management Assessment History: duration, comorbidities, previous ulcers Local Examination of the foot (ulcer, infection, gangrene, deformity) Vascular assessment (pulses, ABI) Neuropathy assessment (monofilament, tuning fork) Systemic examination Investigations: Doppler, X-ray, wound culture, HbA1c Management principles Glycemic control Offloading pressure (special footwear, casts) Debridement of necrotic tissue Infection control (antibiotics, drainage) Vascular assessment & revascularization if needed Wound dressings and advanced therapies

5. Multidisciplinary Approach • Physician/ Endocrinologist – diabetes control • Vascular surgeon – circulation improvement • Podiatrist – foot care • Infectious disease specialist – infection management • Orthopedic/plastic surgeon – reconstruction • Nurse & physiotherapist – wound care & rehabilitation

6. Case Scenario - 1 48/ M, Known case of Diabetes Mellitu s for 9 years Comorbidities – SHT, peripheral neuropathy Recurrent ulcer on the ball of great toe Diagnosis? Evaluation? Management?

7. Case Scenario -1 48/ M, Known case of Diabetes Mellitu s for 9 years Comorbidities – SHT, peripheral neuropathy Recurrent ulcer on the ball of great toe Diagnosis? Trophic ulcer with osteomyelitis at 1 st MT head Evaluation? X-ray, wound culture, HbA1c Management? Glycemic control Offloading pressure – surgical + appropriate footwear Debridement of necrotic tissue/ Sequestrectomy Infection control

8. Case Scenario - 2 52/ M, Known case of Diabetes Mellitu s for 23 years Comorbidities – SHT, peripheral neuropathy with CKD on HD Forefoot ulcer with discoloration of great toe Diagnosis? Evaluation? Management?

9. Case Scenario - 2 52/ M, Known case of Diabetes Mellitus for 23 years Comorbidities – SHT, peripheral neuropathy with CKD on HD Forefoot ulcer with discoloration of great toe Diagnosis? Critical limb ischemia, infected diabetic foot ulcer with evolving gangrene Evaluation? Doppler/ Angiogram, X-ray, wound culture, HbA1c Management? Glycemic control Revascularization Debridement of necrotic tissue/ Amputation Infection control Reconstruction Offloading pressure – surgical + appropriate footwear

10. Case Scenario - 3 60/ F, Known case of Diabetes Mellitus for 25 years Comorbidities – peripheral neuropathy, PVD Midfoot ulcer with deformity of foot Diagnosis? Evaluation? Management?

11. Case Scenario - 3 60/ F, Known case of Diabetes Mellitus for 25 years Comorbidities – peripheral neuropathy, PVD Midfoot ulcer with deformity of foot Diagnosis? Charcot’s neuroarthropathy with DFU Evaluation? X-ray/MRI, Doppler/ Angiogram, wound culture, HbA1c Management? Glycemic control Revascularization if indicated Debridement of necrotic tissue Infection control TCC Reconstruction Offloading pressure – surgical + appropriate footwear

12. Conclusion DFU management requires early detection and comprehensive care Prevention is key through education and regular foot care Multidisciplinary approach improves outcomes and reduces amputations

13. Thank You!