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The microvascular changes within the skin deserve brief mention. Capillary closure
within the skin mean that injuries often heal very slowly if at all and this has profound
implications for the care of foot ulcers. Foot care is an important part of the care of
the diabetic patient as a small ulcer may rapidly progress and threaten the viability ofthe foot itself. Peripheral neuropathy means patients are often unaware of skin
trauma making foot ulceration more common. Their loss of pain sensation may be
compounded by poor eye sight, if the patients can’t see the ulcers it goes unnoticed
and untreated. As people with diabetes have an increased propensity to bacterial
infection, any untreated skin wound can rapidly get infected and because of poor
circulation once infection has set in it often spreads very rapidly and responds slowly
if at all to treatment. To put this into perspective a patient with a diabetic foot ulcer
requiring antibiotic treatment may be hospitalised for months waiting for a relatively
small ulcer to heal and in many cases amputation is often the only way of dealing with
the infected tissue. This explains why the rate of limb amputation in diabetics is so
much greater than in the general population.


Diabetic foot examination Video

Diabetic foot care Video

Debridement of an Infected Diabetic Foot Video