INTRODUCTION:

With increasing prevalence in type II diabetes, early onset of presentation, lifestyle changes and longevity have led to increased burden of diabetic foot syndrome. Diabetic foot problems range from small callosities to gangrene involving one of more toes and extensive infection.
With increasing prevalence in type II diabetes, early onset of presentation, lifestyle changes and longevity have led to increased burden of diabetic foot syndrome. Diabetic foot problems range from small callosities to gangrene involving one of more toes and extensive infection.
The health care cost and burden of treating a diabetic ulcer is huge and nearly 70% of people with diabetic foot syndrome die within 5 years of a major amputation.
Diabetic foot ulcers may present as over a wide range including arterial ulcers, venous ulcers, trophic or neuropathic ulcers, decubitus ulcers, nail pathology associated ulcers and others.

MANAGEMENT OF DIABETIC FOOT ULCERS

• Initial assessment of the limb as a whole
  

  Conventional X-ray

  1. Detecting fractures,
  2. Foreign bodies
  3. Extent of osteomyelitis

  Vascular assessment-

  1. Ankle-brachial index (ABI).
  2. Colour-coded duplex sonography,
  3. Magnetic resonance angiography (MRA)
  4. Computed tomography angiography (CTA)
     1. Vessels of the pelvis and the leg
  5. Digital subtraction angiography (DSA),

PROCEDURES:

1. Callus excision
2. Offloading
   
   1. External offloading
   2. Internal offloading- capsulotomy, wedge osteotomy, condylectomy to remove the pressure points intrinsic to the ulcer.
3. Tendon surgeries-
   1. Tenotomy- for Flexor hallucis longus and flexor digitorum longus to correct hammer toes, causing ulceration over tip of toes
   2. Lengthening of the extensor tendons of toes
   3. Tendoachilles lengthening
   4. Tendon transfers
4. Local flaps
5. Microsurgery and free tissue transfer
6. Vascular interventions-
   1. Angioplasty
   2. Surgical bypass

IDEAL FOOTWEAR IN DIABETES-