By Michael E. Edmonds, Alethea V. M. Foster, Lee Sanders
3rd writer, Lee. J. Sanders, is the dep. of Veterans Affairs scientific heart, Lebanon, PA. deals sensible and medical recommendation at the administration of long term foot difficulties in individuals with diabetes. Discusses prognosis and therapy, either clinical and surgical. top quality colour pictures illustrated a number of the issues. DNLM: Diabetic Foot--diagnosis.
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Extra resources for A Practical Manual of Diabetic Foot Care
Cymbeline, IV, ii, William Shakespeare) PRESENTATION AND DIAGNOSIS The diabetic foot enters stage 2 when it has developed one or more of the following risk factors for ulceration: neuropathy, ischaemia, deformity, swelling and callus. These risk factors may not cause symptoms. Patients do not, thus, report problems. It is therefore important to screen patients at the annual review, which is an important part of diabetic foot care. A recent evaluation of a diabetic foot screening programme showed that it could prevent major amputations.
Several serious lesions, including early neuropathic and early ischaemic ulcers, pressure ulcers, burns, puncture wounds and infections complicating ulceration, may first present as a bulk. Unless bullae are small, superficial and containing clear fluid, they should be regarded as stage 3 lesions. Small, flaccid bullae can be cleaned and covered with a sterile non-adherent dressing. Large bullae (over 1 cm in diameter) and all tense bullae should be lanced with a scalpel and drained before dressing.
Some swimming pools require people with verrucae to wear verruca socks to avoid cross-infection. The recommended treatment for ablation of painful or spreading verrucae in people with diabetes is cryotherapy with liquid nitrogen. The resulting breakdown of tissue should be kept clean and covered with a dressing. However, treatment with liquid nitrogen can cause severe pain and ulceration and should only be used on stage 1 feet. Treatment with strong acids or silver nitrate is not recommended in diabetic patients.