From the Guidelines
The appropriate management for a 66-year-old female with a past medical history of non-insulin dependent (Type 2) diabetes mellitus, peripheral neuropathy, and status post below-knee amputation (BKA) presenting with a right foot ulceration is to provide prompt and aggressive treatment to prevent infection and promote healing.
Key Considerations
- The patient's history of peripheral neuropathy and BKA increases the risk of foot ulcers and infections, making it essential to manage the ulcer carefully 1.
- The presence of a foot ulcer in a patient with diabetes requires a comprehensive approach, including local wound management, management of any infection, and offloading to reduce mechanical tissue stress on the foot 1.
- Therapeutic footwear with demonstrated pressure relief can help prevent plantar foot ulcers and should be worn by the patient to reduce the risk of recurrence 1.
Management Plan
- Assess the ulcer for signs of infection, such as increased redness, swelling, or purulent discharge, and obtain appropriate specimens for culture if infection is suspected 1.
- Initiate offloading using a non-removable knee-high offloading device or other offloading interventions to reduce mechanical tissue stress on the foot and promote healing 1.
- Prescribe therapeutic footwear with demonstrated pressure relief to prevent plantar foot ulcers and reduce the risk of recurrence 1.
- Optimize glycemic control and manage other risk factors, such as cigarette smoking and foot deformities, to reduce the risk of complications 1.
- Monitor the patient closely for signs of infection or other complications and adjust the management plan as needed 1.
From the Research
Management of Diabetic Foot Ulceration
The management of a 66-year-old female with a past medical history of non-insulin dependent (Type 2) diabetes mellitus, peripheral neuropathy, and status post below-knee amputation (BKA) presenting with a right foot ulceration involves a multidisciplinary approach.
- The patient's history of peripheral neuropathy is a significant risk factor for foot ulceration, as it can lead to a loss of sensation and increased pressure on the foot 2, 3.
- Effective management of the patient's diabetes is crucial in preventing further complications, including foot ulceration and amputation 4.
- A team approach to diabetic foot problems, including a podiatrist, specialist nurse, and orthotist, is essential in providing treatment for active ulcers and preventing further complications 3.
- Pressure relieving treatment strategies can help to improve the morphopathological characteristics of neuropathic lesions and promote healing 2.
Risk Factors for Amputation
The patient's history of BKA and peripheral neuropathy increases the risk of further amputation.
- Factors such as poor blood sugar control, diabetic nephropathy, and arteriosclerosis obliterans can also contribute to the risk of amputation 5.
- Skin thermography can be an effective determinant of amputation level, helping to avoid reamputation 5.
- The patient's age, gender, and temperature of the amputation site are also significant risk factors for reamputation 5.
Treatment of Diabetic Foot Ulceration
Treatment of diabetic foot ulceration should focus on promoting healing, preventing infection, and reducing the risk of further complications.