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Orthopaedics
The Diagnosis and Treatment of Diabetic Foot Infections
Built from The Surgical Management of the Diabetic Foot and Ankle
What’s inside
7 sections · 101 slides
Overview
- Scope of the problem
- How the deck is organised
- Typical clinical presentation
Risk factors and pathophysiology
- Peripheral neuropathy as the leading risk factor
- Semmes-Weinstein 5.07 monofilament threshold
- Monofilament testing at the toe pulp
- Motor consequences of peripheral neuropathy
- Shearing forces over bony prominences
- Common sites of tissue breakdown
- Diabetic foot with hallux valgus and hammertoes
- Vasomotor consequences of peripheral neuropathy
- Local risk factors for ulcer and infection
- Bony deformity and systemic risk factors
- Cognitive deficits and patient education
- Therapeutic footwear in preventive care
- Construction of commercial therapeutic footwear
Evaluation of diabetic foot infections
- Origin of the wound and bacterial colonisation
- Colonisation versus clinical infection
- Determinants of progression to infection
- Historical clues suggesting infection
- Differentiating infection from Charcot foot arthropathy
- Consequences of misdiagnosing Charcot arthropathy
- The probe-to-bone test
- Probing a foot wound to bone
- Culture technique and empiric antibiotic therapy
- Indications for arterial and venous assessment
- Noninvasive vascular laboratory studies
- Laboratory evaluation of suspected foot infection
- Plain radiography in suspected osteomyelitis
- Magnetic resonance imaging and nuclear medicine scans
- Causes of lower extremity amputation in diabetes
- The ankle brachial index
- Indications for noninvasive testing and vascular consultation
- Clinical predictors of wound healing potential
- Objective metrics of wound healing potential
Classification and treatment
- Classification systems for diabetic foot infection
- Treatment implications of the Wagner grades
- Wagner-Meggitt classification system
- Wagner grade 0: the limb at risk
- Preventive measures for the at-risk limb
- Wagner grade I: superficial ulcer
- Debridement and offloading of superficial ulcers
- The healing shoe
- Wagner grade II: deep ulcer without bony involvement
- Debridement and wound management in grade II
- Debridement of callus surrounding an ulcer
- Wagner grade III: deep infection and osteitis
- Medical optimisation before surgical debridement
- Surgical technique for deep debridement
- Antibiotic duration and open wound management
- Wound closure options after infection is resolved
- Osteomyelitis of the first metatarsophalangeal joint
- Osteomyelitis of the hallux interphalangeal joint
Forefoot amputation and reconstruction
- Function of the forefoot as a lever arm
- Principles of amputation for infection
- Hallux amputation and medial column stability
- Lesser toe amputation and the forefoot parabola
- Complications of complete second toe resection
- First ray resection
- Fifth ray resection and late varus deformity
- Central ray resection
- Cosmetic and functional results of ray resection
- Ray resection appearance in therapeutic footwear
Gangrene, sepsis and proximal amputation
- Wagner grade IV: forefoot gangrene
- Staged approach to infected forefoot gangrene
- Microbiology of diabetic foot infection
- Role of infectious disease consultation
- Open wound therapy and vacuum-assisted closure
- Protein depletion and systemic optimisation
- Sequence of resection and reconstruction
- Midfoot amputation levels
- Flap choice and metatarsal level in midfoot amputation
- Prevention of late equinus after midfoot amputation
- Amputation at the transverse tarsal joint
- Syme's ankle disarticulation
- Syme's amputation in a one-stage surgery
- Wagner grade V
- Presentation of necrotizing fasciitis
- Surgical management of necrotizing fasciitis
- Planning the definitive amputation level
- Long plantar flap for midfoot amputation
- Historical management of the infected Charcot foot
- Current management of the infected Charcot foot
- Charcot deformity corrected with a circular external fixator
Summary and references
- Comorbidity burden in the infected diabetic foot
- Principles of management
- Key clinical thresholds
- References
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- References (continued)
- The Surgical Management of the Diabetic Foot and Ankle