Faculty of nursing Technical

institute of nursing Diabetic foot

Prepared by:
2nd year students
Group C5
under supervision :
Dr. Doaa
2025/2024

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Prepared by:

1. Mohamed Ramadan Fathy Shehata

2. Mohamed Sami Abdelghani
3. Mohamed Saad Mohamed Ibrahim
4. Mohamed Saeed Ibrahim Mohamed
5. Mohamed Saeed Mahmoud Mahmoud
6. Mohamed Salama El Sayed Kilany
7. Mohamed Sayed Ahmed Mohamed
8. Mohamed Shaker Abdel Rady
9. Mohamed Sherif Abdel Ghaib
10. Mohamed Shaaban Kotb
11. Mohamed Sadiq Mohamed
12. Mohamed Salah Ashour
13. Mohamed Salah Abdel Tawab
14. Mohamed Salah Mohamed
15. Mohamed Tarek Mohamed Abu El Zeid
16. Mohamed Adel Thabet
17. Mohamed Adel Mohamed Ibrahim
18. Mohamed Adel Mohamed El Saeed
19. Mohamed Ashour Mohamed
20. Mohamed Atef Hamed
21. Mohamed Abdel-Badie
22. Mohamed Abdel Nabi Mohamed
23. Mohamed Abdel Hamid Ashmawy
24. Mohamed Abdel Mawgoud El Qadi
25. Mohamed Atalla El Sayed
26. Mohamed Ali Ibrahim El Razek

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Outline:

Introduction
Definition
Causes
Risk Factors
Signs and Symptoms
Stages of Diabetic Foot (Wagner Classification)
Types of Diabetic Foot Lesions
Investigations
Complications
Treatment
Interventions
Surgical treatment
Instruments
Pre operative care
Equipment used to operation
Pre operation
During operation
After operation
Role of circulating nurse
Post operative care
Health teaching
Prevention
References

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Introduction:

Diabetic foot is a severe complication of

diabetes mellitus, particularly prevalent
among the elderly. It encompasses a
range of pathologies, including
neuropathy, peripheral arterial disease
(PAD), and foot ulcers, which can lead to
infections, gangrene, and amputations if
untreated. Due to age-related factors
such as reduced immunity, poor
circulation, and delayed wound healing,
elderly diabetic patients are at higher
risk. Early detection and proper
management are crucial to preventing
disability and improving quality of life.

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 Definition:

Diabetic foot refers to ulceration, infection, or

destruction of deep tissues in the foot associated with
diabetes-related neuropathy and/or peripheral vascular
disease. It is classified based on severity, ranging from
mild ulcers to severe gangrene requiring amputation.

Causes:

1. Peripheral Neuropathy – Nerve damage reduces

sensation, leading to unnoticed injuries.
2. Peripheral Arterial Disease (PAD) – Poor blood flow
impairs wound healing.
3. Hyperglycemia – High blood sugar weakens immune
response and delays healing.
4. Foot Deformities – Bunions, hammertoes, and Charcot
foot increase ulcer risk.
5. Infections – Untreated wounds can become infected
(bacterial/fungal).

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Risk Factors:

- Age (>65 years)

- Long diabetes duration (>10 years)
- Poor glycemic control (high HbA1c)
- Smoking (worsens circulation)
- Obesity
- History of foot ulcers/amputations
- Renal disease
- Visual impairment (difficulty inspecting feet)

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Signs and Symptoms:

- Early Signs:
- Numbness, tingling, burning pain (neuropathy)

- Dry, cracked skin

- Calluses or corns

- Advanced Signs:
- Non-healing ulcers (often painless due to neuropathy)

- Swelling, redness, warmth (signs of infection)

- Foul-smelling discharge (indicating gangrene or deep

infection)

- Blackened tissue (necrosis)

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Stages of Diabetic Foot

Stage Description
No ulcer, but high-risk foot (deformity, callus)

Superficial ulcer (no infection)

Deep ulcer (involving tendons, joints)

Gangrene in part of foot (toe, forefoot)

Extensive gangrene (whole foot at risk)

Types of Diabetic Foot

Lesions
1. Neuropathic Ulcer – Painless, well-defined edges, often
on pressure points.
2. Ischemic Ulcer – Painful, pale/dark wound, poor
healing due to poor blood flow.
3. Neuro-ischemic Ulcer – Combination of neuropathy
and poor circulation.
4. Infected Ulcer – Pus, swelling, redness, fever.

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Investigations

- Blood Tests: HbA1c, CBC (infection), CRP, renal

function
- Microbiological Tests: Wound swab for culture (identify
bacteria/fungi)

- Imaging:
- X-ray (bone involvement, osteomyelitis)
- MRI (deep infections, abscesses)
- Doppler ultrasound (blood flow assessment)
- Neurological Tests: Monofilament test (assess
sensation)
- Vascular Tests: Ankle-Brachial Index (ABI) for PAD

Complications

- Cellulitis & Abscess (soft tissue infection)

- Osteomyelitis (bone infection)
- Gangrene (tissue death)
- Sepsis (life-threatening infection)
- Amputation (toe, foot, or leg)
- Increased Mortality (due to systemic infections)

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Treatment

Medical Management
- Glycemic Control (Insulin/oral hypoglycemics to maintain HbA1c <7%)

- Antibiotics (for infected ulcers, e.g., amoxicillin-

clavulanate, metronidazole)

Wound Care:
- Debridement (removal of dead tissue)
- Moist dressings (hydrogels, alginate)
- Offloading (special shoes, casts to reduce pressure)

Vascular Surgery
(angioplasty, bypass for PAD)
- Hyperbaric Oxygen Therapy (for non-healing wounds)

Surgical Management
- Debridement (removal of infected tissue)
- Amputation (if gangrene or severe infection)

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Interventions

1.Daily Foot Inspection – Check for cuts, blisters, redness.

2. Proper Foot Hygiene – Wash with mild soap, dry thoroughly

(especially between toes).

3. Moisturize (avoid between toes to prevent fungal growth).

4. Prevent Trauma – Avoid walking barefoot, wear well-fitted shoes.

5. Educate on Foot Care – Teach self-examination and nail care.

6. Monitor Blood Sugar – Ensure tight glycemic control.

7. Wound Dressing – Use sterile techniques for ulcer care.

Surgical Treatment
Surgical intervention is often necessary for diabetic foot
complications, such as:

- Debridement: Removal of necrotic or infected tissue.

- Amputation: Partial (toe, foot) or major (below/above knee) in

severe cases.

- Revascularization: Bypass surgery or angioplasty to restore

blood flow.
- Skin grafts/flap surgery: For wound coverage after debridement.

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Instruments

-Common surgical instruments include:

- Scalpel, forceps, scissors (for debridement).
- Bone saw, rongeurs (for amputation).
- Retractors, electrocautery (for hemostasis).
- Sutures, staplers (for wound closure)

Pre-Operative Care

- Assessment: Blood sugar control, infection status,

vascular function.
- Antibiotics: Given if infection is present.
- Glycemic control: Optimizing blood glucose levels.
- Patient education: Discussing procedure, risks, and
post-op care.

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Equipment Used in Operation

-1 Operating table (adjustable for positioning).

-2 Diathermy machine (for cauterization).

-3 Suction apparatus (to clear fluids).

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-4 Surgical lights, sterilized drapes, gloves.

-5 Doppler ultrasound (for vascular assessment).

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 Pre-Operation (Patient Preparation)

- NPO (Nothing by mouth) for 6-8 hours before surgery.

- IV antibiotics & fluids as needed.
- Skin preparation: Antiseptic cleansing (e.g.,
chlorhexidine).
- Positioning: Based on surgical site (supine, lateral).

During Operation

- Anesthesia: Local, regional, or general anesthesia.

- Sterile technique: To prevent infection.
- Surgical steps: Debridement/amputation → Hemostasis
→ Closure.
- Monitoring: Vital signs, blood loss, glucose levels.

After Operation (Immediate Post-Op)

- Pain management: IV/oral analgesics.

- Wound care: Sterile dressing, drainage monitoring.
- Monitoring for complications: Bleeding, infection, poor
healing.
- Early mobilization: If possible, to prevent DVT.

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Role of Circulating Nurse

- Ensures sterility in the OR.

- Prepares and hands instruments to the scrub nurse.

- Monitors patient vitals and anesthesia.

- Documents the procedure and counts surgical tools (preventing

retained items).

- Assists in emergency situations (e.g., hemorrhage).

Post-Operative Care

- Wound inspection: Daily dressing changes, signs of infection.

- Infection control: Continued antibiotics if needed.

- Blood sugar management: Tight glycemic control.

- Physical therapy: For mobility (especially after amputation).

- Follow-up: Regular check-ups for healing progress.

Health Teaching

- Foot hygiene: Daily inspection, proper cleaning.

- Proper footwear: Cushioned, well-fitted shoes to
prevent ulcers.
- Blood sugar control: Diet, medication adherence.
- Signs of complications: Redness, swelling, pus, fever.
- Smoking cessation: Improves circulation.
- Weight management: Reduces pressure on feet

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Prevention

- Regular Foot Exams (by healthcare provider)

- Proper Footwear (cushioned, non-constrictive shoes)

- Avoid Smoking (improves circulation)

- Control Blood Sugar, BP, Cholesterol

- Exercise (promotes circuation)

References

1. American Diabetes Association. (2023). Standards of medical

care in diabetes—2023. *Diabetes Care, 46*(Suppl. 1), S1–S207.
https://doi.org/10.2337/dc23-Srev

2. Armstrong, D. G., Boulton, A. J. M., & Bus, S. A. (2017). Diabetic

foot ulcers and their recurrence. *New England Journal of
Medicine, 376*(24), 2367–2375.
https://doi.org/10.1056/NEJMra1615439

3. International Working Group on the Diabetic Foot (IWGDF).

(2023). IWGDF guidelines on the prevention and management of
diabetic foot disease. https://iwgdfguidelines.org

4. Lipsky, B. A., Senneville, É., Abbas, Z. G., et al. (2020).

Guidelines on the diagnosis and treatment of foot infection in
persons with diabetes (IWGDF 2019 update).
*Diabetes/Metabolism Research and Reviews, 36*(S1), e3280.
https://doi.org/10.1002/dmrr.3280

5. National Institute for Health and Care Excellence (NICE).

(2019). Diabetic foot problems: Prevention and management
(NG19). https://www.nice.org.uk/guidance/ng19

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6. Singh, N., Armstrong, D. G., & Lipsky, B. A. (2005). Preventing
foot ulcers in patients with diabetes. *JAMA, 293*(2), 217–228.
https://doi.org/10.1001/jama.293.2.217

7. Zhang, P., Lu, J., Jing, Y., et al. (2017). Global epidemiology of
diabetic foot ulceration: A systematic review and meta-analysis.
*Annals of Medicine, 49*(2), 106–116.
https://doi.org/10.1080/07853890.2016.1231932

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