L97/L08.8 + (E10.5/E11.5/E12.5/E13.5/E14.5)
DESCRIPTION
Ulcers develop at the tips of the toes and on the plantar surfaces of the metatarsal heads and are often preceded by callus formation.
If the callus is not removed, then haemorrhage and tissue necrosis occur below the plaque of callus, which leads to ulceration. Ulcers can be secondarily infected by staphylococci, streptococci, coliforms, and anaerobic bacteria which can lead to cellulitis, abscess formation, gangrene, and osteomyelitis.
DIAGNOSIS
The three main factors that lead to tissue necrosis in the diabetic foot are:
- neuropathy,
- infection, and
- ischaemia.
GENERAL MEASURES
- Metabolic control.
- Treat underlying comorbidity.
- Relieve pressure: non-weight bearing is essential.
- Smoking cessation is essential.
- Frequent (e.g. weekly) removal of excess keratin by a chiropodist with a scalpel blade to expose the floor of the ulcer and allow efficient drainage of the lesion.
- Cleanse with sodium chloride 0.9% solution daily and apply non-adherent dressing.
MEDICINE TREATMENT
- Amoxicillin/clavulanic acid, oral, 875/125 mg 12 hourly for 10 days.
Severe penicillin allergy: Z88.0
Refer.
REFERRAL
Urgent
Threatened limb, i.e. if the ulcer is associated with:
- cellulitis,
- severe hyperglycaemia
- abscess,
- discolouration of surrounding skin, or
- crepitus.
Non-urgent
- Claudication.
- Ulcers not responding to adequate treatment.
- Severe penicillin allergy.