Diabetic foot (mechanism of disease)

ERRATA (thank you to commenters):
Claw toe has dip flexion (not extension).
This is a flowchart on the diabetic foot, covering the etiology, pathophysiology, and manifestations.
ADDITIONAL TAGS:
Risk factors / SDOH
Cell / tissue damage
Structural factors
Medicine / iatrogenic
Infectious / microbial
Biochem. / metabolic
Immunology / inflammation
Signs / symptoms
Tests / imaging / labs
Environmental / exposure
Nervous system pathology
Flow physiology
Pathophysiology
Etiology
Manifestations
Diabetic foot
Foot ulcers: skin breakdown with possible surrounding
tissue necrosis
Diabetic foot ulcer, classified as …
Neuropathic ulcers
Neuroischemic ulcers
Ischemic ulcers
Peripheral sensory neuropathy
Autonomic neuropathy
Peripheral artery disease
Microvascular changes
Diabetes mellitus
Chronic hyperglycemia
Sorbitol accumulation in cells
Ulcers at sites of repetitive stress/trauma: bony abnormalities, bottom of foot (metatarsal bones or heel)
Ulcers on the toes or lateral foot
Usually painless
+/- sensory loss, motor weakness
+/- cool foot, no palpable pulses
Infection
Trauma
Calluses
↑ rates of …
Hospitalization
Amputation
Death
Skin and soft tissue infection
In ~50% of ulcers
Staphylococcus spp.
Streptococcus spp.
Typically polymicrobial
Most common causative pathogens:
Edema
Induration
Erythema 0.5 cm
Tenderness
Warmth
Purulent exudate
↓ cytokine production
Defects in phagocytosis
Immune cell dysfunction
Diabetes mellitus impairs immune system
Diabetic foot osteomyelitis
Ulcer overlying bony prominence, exposed bone
Ulcer size 2 cm2 and / or ulcer depth 3 mm
Chronic, treatment-resistant ulcer
Positive probe-to-bone test
Markedly increased ESR (70 mm/hour)
Leukocytosis
↓ intrinsic muscle volume
Thickening of plantar aponeurosis
Bone destruction
Subluxation / dislocation
Gas gangrene
By Heather Murphy-Lavoie - www.ncbi.nlm.nih.gov/books/NB..., CC BY 4.0, commons.wikimedia.org/w/index...
Hammer toe: PIP joint flexion; +/- DIP joint extension, +/- MTP joint hyperextension
Claw toe: PIP joint flexion, DIP joint extension, and MTP joint hyperextension
Inflammation: swelling, warmth, erythema
Diabetic neuropathic arthropathy (Charcot foot)
Mild to moderate pain
Midfoot collapse (rocker- bottom foot deformity)
Osteolysis → fractures
Painless bony deformities

[@Muskaan__12345]

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[@Natjwaaulias]

Great video! Very easy to understand!

[@dharanisudha7]

Awesome ❤

[@AnnloisewanguiGitau-yh2fz]

My mum got stroke and she's diabetic sadly her paralyzed foot has those ulcers.

[@pipphelpsfineartanddesign9681]

Claw toe has dip flexion, not extension

[@pgmerovingian]

can hyperbaric treatment help

[@hmoodqsh2359]

Thanks for this great vid / regarding claw toe I think it DIP flexion not extension

[@lordabd5580]

Thanks ❤
Can we have this diagrams as PDF file ?

[@MitsuJohnnyLancer]

I want too

[@JimmyNalishebo-yu9bg]

Good news

[@Happylillovebunny]

Me, an aspiring professional: did he say "looks like a hammer and a toe?" 😂😂😂

[@leomawalker4354]

Gangrene

[@sudhirmishra6429]

Please Hind ma batyaga

[@sudhirmishra6429]

Problem 8 sal sa ha😢😂