ulcer of the foot

8/18/2019 Ulcer of the Foot

1/21


2/21

DEFINITION

• Infection condition in whichpathogenic ogani!"! "#$tip$y %!pead within the &ody ti!!#e!

• In'a""atoy eaction( which i! the&ody)! way of co"&ating thein*ade! and de!toying the"

• +ign of in'a""ation : edne!!(!we$$ing( heat( pain and $o!! off#nction


3/21

ETIOLO,-

• Diect intod#ction tho#gh the !.in apinpic.( an in/ection( a !ta& wo#nd( a$aceation( an open fact#e o an

opeation• Diect !pead fo" a contig#o#! foc#! of

infection

• Indiect !pead *ia the &$ood !tea" fo" adi!tant !ite !#ch a! the no!e o "o#th( thee!piatoy tact( the &owe$ o thegenito#inay tact


4/21

ANA0NE+I+

• 1ain

• A&i$ity to &ea weight

• +#&/ecti*e fe*e! o

chi$$!• Recent ta#"a

• 1io infection!

• Change! in acti*ity

• Footwea

• Hygiene

• +y!te"iccondition! – dia&ete!

–peiphea$ *a!c#$adi!ea!e

– chonic $i*e o.idney di!ea!e

–

i""#no!#ppe!!i*e!tat#!

– go#t


5/21

1H-+ICAL E2A0INATION+

• 3ita$ !ign! % o*ea$$ "enta$ !tat#! toa!!e!! fo !y!te"ic infection

• A4ected e5te"ity !ho#$d &eco"paed with the #na4ectede5te"ity

• Defo"ity o othe o&/ecti*e 6nding! – Eythe"a

– Ecchy"o!i!

– +we$$ing


6/21

1H-+ICAL E2A0INATION+

• Integity of the !.in !ho#$d &e a!!e!!ed foca$$#!e! o &$i!te! and dainage

• +.in wa"th "ay &e noted in the a4ected

e5te"ity• 1$anta foot !en!ation !ho#$d &e a!!e!!ed

• Do!a$i! pedi! % po!teio ti&ia$ p#$!e!!ho#$d &e gaded *ia pa$pation o Dopp$e

#$ta!o#nd

• 1ef#!ion of the toe! !ho#$d &e a!!e!!ed *iacapi$$ay e6$$ ti"e


7/21

LABORATOR-E2A0INATION+

• White &$ood ce$$ 7WBC8

• Eythocyte !edi"entation ate 7E+R8

•

C9eacti*e potein 7CR18• Di!ea!e9!peci6c "a.e!:

– He"og$o&in AC 7no"a$ ange( ;< to=


8/21

RADIO,RA1HIC E3ALUATION

• Initia$ i"aging !ho#$d inc$#deweight&eaing p$ain adiogaph! toa!!e!! fo fact#e! o di!$ocation!(

foeign &odie!( !#&c#taneo#!e"phy!e"a( and a!!ociateddegeneati*e change!


9/21

RADIO,RA1HIC E3ALUATION

• CT can &e #!ed to f#the e*a$#ate the&ony achitect#e

• +#!picion of o!teo"ye$iti! "ay waant

additiona$ e*a$#ation with 0RI• N#c$ea "edicine !t#die!( inc$#ding

techneti#" Tc9" and indi#"9In9 $a&e$ed $e#.ocyte !can!( can &e #!ed inthe !etting of e#i*oca$ 6nding! o e$ati*econtaindication! to othe i"agingtechni#e!


10/21

ADDITIONAL E3ALUATION

• Ba!ic a!!e!!"ent of *a!c#$a !#pp$y"#!t &e pefo"ed in a$$ ca!e! offoot infection

• An.$e9&achia$ inde5 7ABI8( inc$#dingdo!a$i! pedi! and toe wa*epe!!#e! and wa*e fo"!( "ay &e

o&tained to a!!e!! e$ati*e $age9*e!!e$ pef#!ion to the e5te"ity


11/21


12/21

ADDITIONAL E3ALUATION

• D#p$e5 #$ta!onogaphy i! anonin*a!i*e "ethod that can &e #!edto !ceen fo ateia$ !teno!e! and

*eno#! o#t'ow o&!t#ction oin!#ciency


13/21

TREAT0ENT

The pincip$e! of teat"ent ae:

78 to po*ide ana$ge!ia and genea$ !#ppoti*e"ea!#e!J

78 to e!t the a4ected patJ

7>8 to identify the infecting ogani!" and ad"ini!te

e4ecti*e anti&iotic teat"ent o che"otheapyJ

7;8 to e$ea!e p#! a! !oon a! it i! detectedJ

7@8 to !ta&i$iKe the &one if it ha! fact#edJ

7=8 to eadicate a*a!c#$a and necotic ti!!#eJ

78 to e!toe contin#ity if thee i! a gap in the &oneJ

7M8 to "aintain !oft9ti!!#e and !.in co*e


14/21

TREAT0ENT

+oft9ti!!#e infection

• Fi!t9$ine theapy i! "edica$( andinitia$ anti"ico&ia$ agent! !ho#$dinc$#de co*eage of !teptococci and!taphy$ococci in the !etting ofta#"a

• Dic$o5aci$$in( cepha$e5in( oeytho"ycin


15/21

TREAT0ENT

+oft9ti!!#e infection

• If "ethici$$ine!i!tant S aureus issuspected, then #!e of c$inda"ycin(ti"ethopi"!#$fa"etho5aKo$e(*anco"ycin( dapto"ycin( o $ineKo$id"ay &e e#ied


16/21

TREAT0ENT

Dia&etic foot


17/21

TREAT0ENT

• Indication! fo !#gica$ inte*ention inpatient! with o!teo"ye$iti! of the $owee5te"ity ae $age$y dependent on etio$ogy

•

Ea$y agge!!i*e d&ide"ent i! nece!!ayfo "anage"ent of penetating ta#"aticin/#ie! o open wo#nd!( wheea! ea$yd&ide"ent in the !etting of chonic

di!ea!e and !y!te"ic i$$ne!! i! conto*e!ia$&eca#!e accepta&$e e!#$t! ha*e &eenepoted with non!#gica$ theapy a$one


18/21

CO01LICATION+

• A $etha$ o#tco"e fo" !epticae"ia i!nowaday! e5te"e$y aeJ withanti&iotic! the chi$d nea$y a$way!

eco*e! and the &one "ay et#n tono"a$

• B#t "o&idity i! co""on( e!pecia$$y if

teat"ent i! de$ayed o the ogani!"i! in!en!iti*e to the cho!en anti&iotic


19/21

CO01LICATION+

• +#pp#ati*e athiti!

• 0eta!tatic infection

•

1atho$ogica$ fact#e• Chonic o!teo"ye$iti!


20/21

THANK

YOU


21/21

REFERENCE+

• Ap$ey)! +y!te" of Othopaedic! andFact#e! th ed

• o#na$ of the A"eican Acade"y of

Othopaedic +#geon! J :=M;9=>• Te5t&oo. of Di!ode! and In/#ie! of the

0#!c#$o!.e$eta$ +y!te" >d ed( Ro&et B?+a$te

• Ca"p&e$$)! Opeati*e Othopaedic! th ed

• 0i$$e Re*iew of Othopaedic! @th ed

ulcer of the foot

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