Curriculum · Metabolic and Endocrine and Diabetes Mellitus
Diabetic foot ulcer
What it is
A patient with a diabetic foot is very common in the OSCE, so you need to know how to examine and describe ulcers. In any ulcer you comment on 4 things: the margin, which is the area around the ulcer and may be ulcerating; the edge; the floor, which is what you see; and the base, which is the structure under the floor and which you do not see.
Causes and risk
The most important contributing factor for diabetic foot ulcers is diabetic neuropathy, that is loss of protective sensation, small muscle atrophy, abnormal vascular tone, and decreased sweating with fissures. The other risk factors are arterial insufficiency, end-stage renal disease in a patient on dialysis, and smoking. The same ulcer is set out again beside the other ulcer types, and there the list reads: common in diabetes, hyperglycemia, micro-/macroangiopathy, neuropathy, infection and foot deformities. In the foot itself the ulcer is usually a combination of arterial and neuropathic ulcers.
How it presents
The location is the plantar surface and the areas under pressure points, for example the bony prominences. At those sites of pressure in the foot there is whitish material around the ulcer called callus.