Diabetes 22, Feet Problems
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Foot and leg problems
Macro and microvascular disease can lead to distal ischaemia eventually resulting in gangrene. As sensory neuropathy can lead to foot desensitisation, patients may not be aware of pressure effects from shoes, this can result in callousformation. Further pressure on hard areas of callous can lead to necrotic damage of underlying tissue. This occurs largely as a result of pressure from overlying callous impeding the blood supply, essentially leading to a pressure ulcer. These ulcers which develop under callous are prone to infection which may migrate down into the bone. This is why diabetic feet should be regularly inspected and areas of callous removed. Care must be taken when removing callous not to damage healthy underlying tissue as such injuries are prone to infection. If an ulcer does form under an area of callous there should be sharp debridement and the ulcer encouraged to heal by secondary intention.