Author/Editor		Rakovec, S; Gaberšek, I; Stanisavljević, D
Title		The diabetic foot - problems of diagnosis and therapy
Type		članek
Source		Diabetol Croat
Vol. and No.		Letnik 20, št. 1
Publication year		1991
Volume		str. 27-33
Language		eng
Abstract		Initial foot changes cause little inconvenience and are hardly noticed by the diabetic patient, but they increase the vulnerability and susceptibility to infection. A developing ulcer also may not be very painful, and the signs of inflammation are poorly prenounced. Therefore, patient come late to the physician, who may overlook the severity of the disease. Careful evaluation should establish the stage of foot lesions (0-5), presence or absence of infection, circulatory compromise, neurologic deficits and other risk factors. The physician must put to use all this clinical knowledge and order all available tests that may be of help. These include laboratory and bacteriological studies, various X-ray investigations, scintigraphy and other techniques to determine the involvement of bone and adjacent tissues, assesment of innervation and non-invasive as well as invasive methods for assessing circulatory impairment. A thorough evaluation is a prerequisite for proper treatment. The therapeutic approach depends largely on the severity of the lesions, circulatory impairment and characteristics of the infection. If the blood supply to the limb is likely to be improved with surgical or nonsurgical procedures, this should by all means be attempted. Local treatment comprises foot care and orthopaedic shoes for inital changes, more or less extensive drainage for superficial ulcers, and amputation of toes, feet or even limbs for deep ulcers and gangrene. Postoperatively, appropriate dressings and careful follow-up are essential. Additional minor or major necrectomy is required in some cases. It is essential that the excicions are wide enough to permit completely free drainage. Still, the treatment should not be too radical. Conclious risking of repeat surgery will cause less harm than the removal of important foot structures that might undergo repair. Antibiotics are an important adjuct to surgical measures.(trunc.)
Descriptors		DIABETIC FOOT ANTIBIOTICS AMPUTATION