Podiatry

Diabetic foot assessment, neuropathic ulcer management, and offloading

Mahesh Pillai, 68M

Diabetic neuropathic foot — right. Dry gangrene toes 1&2.

Grade 4

Sensation: Monofilament: absent 10 sites/10 bilateral. Vibration: absent.

Pulses: DP/PT absent bilaterally. Femoral present.

ABI: Right 0.42 (severe PAD). Left 0.68 (moderate).

Deformity: Charcot deformity right midfoot. Hammer toes 2-4.

Footwear / Offloading: Customised total contact cast (TCC) — right foot offloading.

Vascular review priority — revascularisation decision. Daily dry dressing gangrene toes. TCC for offloading. Glycaemic control (target HbA1c < 7%). If revascularisation not possible: below-knee amputation planning with prosthetist.

Sushila Mehta, 82F

Grade 1 neuropathic ulcer — right heel. CKD-related poor healing.

Grade 1

Sensation: Monofilament: reduced (4/10 sites right, 6/10 left).

Pulses: DP/PT weak bilaterally. Capillary refill 4s.

ABI: Right 0.78. Left 0.82.

Deformity: Calcaneal spur. Heel fissures bilateral.

Footwear / Offloading: Gel heel cushion. Total contact casting deferred — poor tolerance.

Hydrogel dressing right heel ulcer. Debridement of callus borders. Pressure relief sheepskin boots. Nutritional optimisation (albumin target > 3.5). Review monthly or sooner if deteriorating.