Diabetic Foot Ulcer

Exam Cram

• Diabetic Foot Ulcer is a complication of both type 1 & type 2 diabetes, usually a neurogenic ulcer (but can be venous or arterial)

• The infection can be severe due to the diabetic's poor immune system 

• Presentation: painless ulcer (due to peripheral neuropathy) incidentally noticed

• Management: co-amoxiclav, swab +- MRI ?osteomyelitis

Outline

Background

• Core diabetes complication

• Infection usually polymicrobial: aerobics & anaerobes, gram +ve & gram -ve

• Complications include osteomyelitis causing amputation

Assessment

History

• Minor trauma- laceration without pain, didn't notice

• Progressive swelling, eryhtema & purulent dc

Examination

• Ulcer on heel of foot

• Purulent foul smelling discharge

Investigations

• Wound swab +/- MRSA swab

• XR

• Consider MRI ?osteomyelitis

• Ankle-brachial pressure index > 0.7: arterial supply adequate

Diagnosis & Classification

Diagnosis: clinical 

Differential diagnosis: venous, arterial or neurogenic ulcers

Classification: a number of scales with 0 = mild ulcer and 5 = gangrene

Management

Acute Admission

1. Co-amoxiclav (or trust policy)

2. Surgical & podiatry opinion ?debridlement

3. Investigations: wound swab, MRSA, XR +/- MRI ?osteomyelitis

4. IVF if hypovolemia

Discharge planning

1. Diabetes educator +/- Endocrine diabetes review

2. HbA1c

3. Community nurses follow up: dressing routine

4. Hospital in the home candidate

5. Venous ulcers: 3 layer compression bandaging

Resources and References

Written in 2025