By Hanaa Tashkandi
*20% of diabetic patients enter the hospitals for foot problems.
*70% of major leg amputations are done in diabetic patients.
*50% of patients will need a contralateral lower limb amputation within two years.
Foot ulceration.
Foot infection.
Foot gangrene.
**severe sepsis.
**major tissue loss.
**non reconstructable vascular disease.
The energy expenditure in an amputated patient increase by 60%.
So because of that insufficient , most of the amputated diabetic patients are bed or wheel chair bound.
There are three compartments in the sole of the foot:
-medial , lateral and central. -are separated by the medial and lateral
septae.
**The floor : the planter fascia . **The roof the interosseous muscles and metatarsal
bones.
Nerve supply : tibial nerve which enters the foot through
the tarsal tunnel.And the sensibility is provided by the three
terminal branches of the tibial nerve.
The dorsum of the foot: supplied by the dorsalis pedis artery.The planter of the foot:Supplied by the medial and lateral planter
arteries.
The dorsalis pedis artery may be absent or rudimentary in 15% of the population.
Peripheral neuropathy. Peripheral vascular disease. Hematological abnormalities. Immune system impairment.
It is a multidisciplinary care,,, i.e.; general surgery. plastic surgery. vascular surgery.
Evaluation should focus on three major areas;
systemic CAD, pulmonary,renal,CVA. Infection. Neurological status. Endocrine control.
Absolute indication for amputation: severe sepsis. marked tissue loss. critical cardiac and renal condition. previous experience with graft failure or
thrombosis.
Debridement . Drainage of abscess. Application of local antibacterial agents.
1- management of weight bearing areas of the foot.
---metatarsal heads. ---the heal defect.
2-non weight bearing areas. ---forefoot. ---instep region. ---posterior part of hindfoot (Achilles
region) ---dorsum of the foot.