APPROACH TO FOOT ULCER

DEFINITIONAn ulcer is a break in the continuity of the

covering epithelium skin or mucous membrane due t0 molecular death of the cells associated with either acute or chronic inflammation.

Legs & feet are susceptible to ulcer formation.

ETIOLOGYTRAUMATICDIABETICARTERIAL VENOUS MALIGNANCY

OTHER CAUSESERYTHROCYANOID ULCER (BAZIN’S DISEASE)GUMMATOUS ULCERMARTORELL’S ULCERINFECTIVE ULCERS – TB, SYPHILIS,

STAPHYLOCOCCUS, etc.ULCERS COMPLICATING VARIOUS DISEASES

GROSS ANEMIA, POLYCYTHEMIA, LEUKEMIA, RA, PAGET’S, etc.

TROPICAL ULCERYAWSULCER FROM CONGENITAL AV FISTULA

WAGNER’S CLASSIFICATIONGRADE – 0 : NO OPEN LESION, INTACT SKIN-

IMPENDING ULCER (Callus may be present)

WAGNER’S CLASSIFICATIONGRADE – 1 : SUPERFICIAL ULCER

WAGNER’S CLASSIFICATIONGRADE – 2 : DEEP ULCER TO TENDON , CAPSULE

OR BONE

WAGNER’S CLASSIFICATIONGRADE – 3 : DEEP ULCER WITH ABSCESS ,

OSTEOMYELITIS & JOINT SEPSIS

WAGNER’S CLASSIFICATIONGRADE – 4 : LOCALISED GANGRENE

WAGNER’S CLASSIFICATIONGRADE – 5 : GANGRENE OF ENTIRE FOOT

PEDIS CLASSIFICATION

HISTORY - APPROACHDESCRIBING ABOUT THE ULCER

TO ASSESS THE ETIOLOGY OF THE ULCER

SITE

ONSET

DURATION

PROG

RESS

HISTORY OF PAINFEVER DISCHARGE

COLOUR, AMOUNT, TYPE OF DISCHARGE

TO ASSESS ETIOLOGYHISTORY OF

TRAUMASENSATION OF FOOTINTERMITTENT CLAUDICATIONDILATATION OF VEINS/ PROLONGED STANDINGLOSS OF APPETITE/ WEIGHTSWELLING IN GROINDIABETES, HYPERTENSION, TUBERCULOSIS,

VENEREAL DISEASEMEDICATION INTAKESURGERY DONE

ARTERIAL ULCER

VENOUS ULCER

MALIGNANT ULCER

EXAMINATION OF ULCERINSPECTION6 S

SITESIZESHAPESURGACESKINSCAR

NUMBERFLOOREDGE MARGIN

PALPATIONLOCAL TEMPERATURETENDERNESS OF THE EDGE OR BASE OF

ULCERBASE OF ULCERMOBILITY OF ULCER

TO CHECKPERIPHERAL PULSATIONPERIPHERAL SENSATIONANY VENOUS DISEASEDRAINING LYMPHNODES

MONOFILAMENT TESTANKLE BRACHIAL INDEX

DIAGNOSISSIDE, CONDITION OF THE ULCER,

ETIOLOGYEg. Right foot chronic non healing ulcer due

to diabetes.

CAUSES OF NON HEALING ULCERLOCAL FACTORS

LACK OF ADEQUATE REST LACK OF ADEQUATE

IMMOBILISATION REPEATED TRAUMA REPEATED INFECTION PRESENCE OF FOREIGN

BODY PRESENCE OF SEQUESTRUM PRESENCE OF ARTERIAL

DISEASE PRESENCE OF VENOUS

DEISEASE PRESENCE OF LYMPHATIC

DISEASE PRESENCE OF NERVE

DISEASE

GENERAL FACTORS ANEMIA HYPOPROTENEMIA DIABETES MELLITUS TUBERCULOSIS HYPERTENSION CHRONIC LIVER DISEASE CHRONIC RENAL

DISEASE PATIENT ON STEROIDS MALIGNANCY RADIATION CYTOTOXIC DRUGS

INVESTIGATIONSLAB INVESTIGATIONS

Complete Blood CountESRFasting/ Post prandial blood sugarPus swab for Culture SensitivityTissue for culture sensitivityEdge Biopsy

RECOMMENDATION FOR COLLECTING SPECIMENS FOR CULTURE

Obtain culture only if there is clinical evidence of infection,

Debride & cleanse the wound before collecting specimen,

Obtain tissue specimen from ulcer by currettage,

Biopsy of deep tissue or infected bone – c/s,

Avoid sending just wound swab,

Obtain blood culture, if pt. is systemically ill,

Request for gram stained smear of specimen.

ImagingChest X rayLocal foot X rayArterial and Venous Doppler StudyCT Angiography

THANK YOUPROF. DR. BARANI RAJKUMAR