Diabetic foot and Neurophaty

Alief Leisyah

Diabetic Foot

Definition: Infection, ulceration or

destruction of deep tissues associated with neurological abnormalities & various degrees of peripheral vascular diseases in the lower limb

(WHO definition)

STAGES OF ULCER DEVELOPMENT

STAGES OF ULCER DEVELOPMENT

Classification - Wagner

• Grade 0 - Skin intact, no foot deformity

• Grade 1 - Superficial ulcer• Grade 2 - Deep ulcer• Grade 3 - Deep ulcer with infection• Grade 4 - Limited necrosis• Grade 5 - Necrosis of the entire foot

Wagner grade 0

Wagner grade 1

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

Diabetic Neuropathy

• Diabetic neuropathy is the most common complication of diabetes mellitus (DM), affecting as many as 50% of patients with type 1 and type 2 DM.

• Diabetic peripheral neuropathy involves the presence of symptoms or signs of peripheral nerve dysfunction in people with diabetes after other possible causes have been excluded.

Sign and symptoms• In type 1 DM, distal polyneuropathy typically becomes

symptomatic after many years of chronic prolonged hyperglycemia, whereas in type 2, it may be apparent after only a few years of known poor glycemic control or even at diagnosis. Symptoms include the following:

• Sensory – Negative or positive, diffuse or focal; usually insidious in onset and showing a stocking-and-glove distribution in the distal extremities

• Motor – Distal, proximal, or more focal weakness, sometimes occurring along with sensory neuropathy (sensorimotor neuropathy)

• Autonomic – Neuropathy that may involve the cardiovascular, gastrointestinal, and genitourinary systems and the sweat glands

Rapid Screening for Diabetic Neuropathy Using 10 gram Semmes-Weinstein Monofilament

Loss of sensation over the distal plantar surface to the 10g monofilament is a significant and independent predictor of foot ulceration and lower-extremity amputation.

Riwayat Perjalanan Penyakit Pasien

1. Sudah tidak bekerja2. Penyakit DM3. Tidak kontrol4. Putus minum obat 5. Gejala klasik DM +

1. Luka pada kaki kiri2. Awal kecil meluas menjadi borok3. Baal

1. Luka bernanah2. Sedikit darah3. Tidak bisa berjalan2 tahun SMRS

3 minggu SMRS

3 hari SMRS

• Canadian Diabetes Association Clinical Practice Guidelines,Foot Care, Chapter 32, Keith Bowering, John Embil