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. 2020 Aug;55(4):389-396.
doi: 10.1055/s-0039-3402462. Epub 2020 Apr 27.

Diabetic Foot. Part 1: Ulcers and Infections

Ricardo Cardenuto Ferreira  1
Affiliations

Diabetic Foot. Part 1: Ulcers and Infections

Ricardo Cardenuto Ferreira. Rev Bras Ortop (Sao Paulo). 2020 Aug.

Abstract

Diabetes is a systemic disease that has achieved epidemic proportions in modern society. Ulcers and infections are common complications in the feet of patients with advanced stages of the disease, and are the main cause of amputation of the lower limb. Peripheral neuropathy is the primary cause of loss of the protective sensation of the feet and frequently leads to plantar pressure ulcers and osteoarticular disruption, which in turn develops into Charcot neuropathy (CN). Common co-factors that add to the morbidity of the disease and the risk of amputation in this population are obesity, peripheral arterial disease, immune and metabolic disorders. Orthopedic surgeons must be aware that the early detection and prevention of these comorbidities, through diligent medical care and patient education, can avoid these amputations.

Keywords: amputation; diabetes; foot; infection; ulcer.

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Conflict of interest statement

Conflitos de Interesses O autor declara não haver conflitos de interesses.

Figures

Fig. 1
Fig. 1
Lateral ( A ), medial ( B ) and plantar ( C ) images of the right foot, showing the presence of multiple ulcers infected with associated tissue necrosis. In the preoperative radiographic image, performed in the lateral view of the foot, there is a talonavicular dislocation and a plantar protrusion of the cuboid bone in the midfoot ( D ). After surgical debridement and removal of the dislocated cuboid bone, the radiographic image in the lateral view of the foot shows the stabilization of the extremity with the circular external fixator ( E ). Six months after treatment, it was possible to avoid amputation of the extremity and the foot is aligned and free of infection and ulcers ( F and G ).
Fig. 2
Fig. 2
Plantar view of the left foot after surgery for debridement of infected plantar ulcer followed by abscess drainage, removal of devitalized tissue and transmetatarsal partial amputation. The area corresponding to the ulcer was left open and covered with an occlusive dressing with saline moistened gauze. The extremity was stabilized with a circular external fixator and the patient was hospitalized for systemic intravenous antibiotic therapy of broad spectrum.
Fig. 1
Fig. 1
Imagens lateral ( A ), medial ( B ) e plantar ( C ) do pé direito, mostrando a presença de múltiplas úlceras infectadas com necrose tecidual associada. Na imagem radiográfica pré-operatória, realizada na incidência lateral do pé, nota-se luxação talonavicular e saliência plantar do osso cubóide no mediopé ( D ). Após o debridamento cirúrgico e remoção do osso cubóide luxado, a imagem radiográfica na incidência lateral do pé mostra a estabilização da extremidade com o fixador externo circular (E). Seis meses após o tratamento foi possível evitar a amputação da extremidade e o pé encontra-se alinhado e livre da infecção e das úlceras ( F e G ).
Fig. 2
Fig. 2
Vista plantar do pé esquerdo após cirurgia para debridamento de úlcera plantar infectada seguida de drenagem de abscesso, remoção do tecido desvitalizado e amputação parcial transmetatarsal. A área correspondente à úlcera foi deixada aberta e recoberta com curativo oclusivo com gaze umedecida por soro fisiológico. A extremidade foi estabilizada com fixador externo circular e o paciente mantido internado para antibioticoterapia endovenosa sistêmica de largo espectro.
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