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    Ulcer of The Foot

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    M Caesar Novaldy
    This document discusses ulcer of the foot, including its definition as an infection causing pathogens to multiply and spread within body tissues, leading to inflammation. Ulcers can be caused directly through the skin or indirectly via the bloodstream. Evaluation involves examining the foot for signs of infection like swelling and reduced sensation, as well as potentially checking blood markers, imaging, and vascular supply. Treatment principles are to relieve pain, rest the foot, use appropriate antibiotics, drain pus, stabilize bones, remove dead tissue, restore bone continuity, and maintain soft tissue coverage. Complications can include arthritis, metastatic infection, fractures, and chronic osteomyelitis if treatment is delayed or the organism is antibiotic-resistant.

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    Ulcer of The Foot

    Uploaded by

    M Caesar Novaldy
    19 views21 pages
    This document discusses ulcer of the foot, including its definition as an infection causing pathogens to multiply and spread within body tissues, leading to inflammation. Ulcers can be caused directly through the skin or indirectly via the bloodstream. Evaluation involves examining the foot for signs of infection like swelling and reduced sensation, as well as potentially checking blood markers, imaging, and vascular supply. Treatment principles are to relieve pain, rest the foot, use appropriate antibiotics, drain pus, stabilize bones, remove dead tissue, restore bone continuity, and maintain soft tissue coverage. Complications can include arthritis, metastatic infection, fractures, and chronic osteomyelitis if treatment is delayed or the organism is antibiotic-resistant.

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    kuliah ulcer kaki

    Original Title

    Ulcer of the Foot

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    This document discusses ulcer of the foot, including its definition as an infection causing pathogens to multiply and spread within body tissues, leading to inflammation. Ulcers can be caused directly through the skin or indirectly via the bloodstream. Evaluation involves examining the foot for signs of infection like swelling and reduced sensation, as well as potentially checking blood markers, imaging, and vascular supply. Treatment principles are to relieve pain, rest the foot, use appropriate antibiotics, drain pus, stabilize bones, remove dead tissue, restore bone continuity, and maintain soft tissue coverage. Complications can include arthritis, metastatic infection, fractures, and chronic osteomyelitis if treatment is delayed or the organism is antibiotic-resistant.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    19 views21 pages

    Ulcer of The Foot

    Uploaded by

    M Caesar Novaldy
    This document discusses ulcer of the foot, including its definition as an infection causing pathogens to multiply and spread within body tissues, leading to inflammation. Ulcers can be caused directly through the skin or indirectly via the bloodstream. Evaluation involves examining the foot for signs of infection like swelling and reduced sensation, as well as potentially checking blood markers, imaging, and vascular supply. Treatment principles are to relieve pain, rest the foot, use appropriate antibiotics, drain pus, stabilize bones, remove dead tissue, restore bone continuity, and maintain soft tissue coverage. Complications can include arthritis, metastatic infection, fractures, and chronic osteomyelitis if treatment is delayed or the organism is antibiotic-resistant.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 21

    ULCER OF THE FOOT

    By : AW

    DEFINITION
    Infection condition in which
    pathogenic organisms multiply &
    spread within the body tissues
    Inflammatory reaction, which is the
    bodys way of combating the
    invaders and destroying them
    Sign of inflammation : redness,
    swelling, heat, pain and loss of
    function

    ETIOLOGY
    Direct introduction through the skin a
    pinprick, an injection, a stab wound, a
    laceration, an open fracture or an
    operation
    Direct spread from a contiguous focus of
    infection
    Indirect spread via the blood stream from a
    distant site such as the nose or mouth, the
    respiratory tract, the bowel or the
    genitourinary tract

    ANAMNESIS
    Pain
    Ability to bear weight
    Subjective fevers or
    chills
    Recent trauma
    Prior infections
    Changes in activity
    Footwear
    Hygiene

    Systemic
    conditions
    diabetes
    peripheral vascular
    disease
    chronic liver or
    kidney disease
    immunosuppressive
    status
    gout

    PHYSICAL EXAMINATIONS
    Vital signs & overall mental status to
    assess for systemic infection
    Affected extremity should be
    compared with the unaffected
    extremity
    Deformity or other objective findings
    Erythema
    Ecchymosis
    Swelling

    PHYSICAL EXAMINATIONS
    Integrity of the skin should be assessed for
    calluses or blisters and drainage
    Skin warmth may be noted in the affected
    extremity
    Plantar foot sensation should be assessed
    Dorsalis pedis & posterior tibial pulses
    should be graded via palpation or Doppler
    ultrasound
    Perfusion of the toes should be assessed via
    capillary refill time

    LABORATORY
    EXAMINATIONS

    White blood cell (WBC)


    Erythrocyte sedimentation rate (ESR)
    C-reactive protein (CRP)
    Disease-specific markers:
    Hemoglobin A1C (normal range, 4% to
    6%)

    Nutritional markers:
    Albumin (normal range, 3.4 to 5.4 g/Dl)

    RADIOGRAPHIC EVALUATION
    Initial imaging should include
    weightbearing plain radiographs to
    assess for fractures or dislocations,
    foreign bodies, subcutaneous
    emphysema, and associated
    degenerative changes

    RADIOGRAPHIC EVALUATION
    CT can be used to further evaluate the
    bony architecture
    Suspicion of osteomyelitis may warrant
    additional evaluation with MRI
    Nuclear medicine studies, including
    technetium Tc-99m and indium-In- 111
    labeled leukocyte scans, can be used in
    the setting of equivocal findings or relative
    contraindications to other imaging
    techniques

    ADDITIONAL EVALUATION
    Basic assessment of vascular supply
    must be performed in all cases of
    foot infection
    Ankle-brachial index (ABI), including
    dorsalis pedis and toe wave
    pressures and wave forms, may be
    obtained to assess relative largevessel perfusion to the extremity

    ADDITIONAL EVALUATION
    Normal ABI is >0.9
    Index of <0.45 is predictive of a poor
    healing response
    Toe wave pressures of 0.45 and 0.2
    mm Hg are predictive of good and
    poor healing responses, respectively

    ADDITIONAL EVALUATION
    Duplex ultrasonography is a
    noninvasive method that can be used
    to screen for arterial stenoses and
    venous outflow obstruction or
    insufficiency

    TREATMENT
    The principles of treatment are:
    (1) to provide analgesia and general supportive
    measures;
    (2) to rest the affected part;
    (3) to identify the infecting organism and administer
    effective antibiotic treatment or chemotherapy;
    (4) to release pus as soon as it is detected;
    (5) to stabilize the bone if it has fractured;
    (6) to eradicate avascular and necrotic tissue;
    (7) to restore continuity if there is a gap in the bone;
    (8) to maintain soft-tissue and skin cover

    TREATMENT
    Soft-tissue infection
    First-line therapy is medical, and
    initial antimicrobial agents should
    include coverage of streptococci and
    staphylococci in the setting of
    trauma
    Dicloxacillin, cephalexin, or
    erythromycin

    TREATMENT
    Soft-tissue infection
    If methicillinresistant S aureus is
    suspected, then use of clindamycin,
    trimethoprimsulfamethoxazole,
    vancomycin, daptomycin, or linezolid
    may be required

    TREATMENT
    Diabetic foot

    TREATMENT
    Indications for surgical intervention in
    patients with osteomyelitis of the lower
    extremity are largely dependent on etiology
    Early aggressive dbridement is necessary
    for management of penetrating traumatic
    injuries or open wounds, whereas early
    dbridement in the setting of chronic
    disease and systemic illness is controversial
    because acceptable results have been
    reported with nonsurgical therapy alone

    COMPLICATIONS
    A lethal outcome from septicaemia is
    nowadays extremely rare; with
    antibiotics the child nearly always
    recovers and the bone may return to
    normal
    But morbidity is common, especially if
    treatment is delayed or the organism
    is insensitive to the chosen antibiotic

    COMPLICATIONS

    Suppurative arthritis
    Metastatic infection
    Pathological fracture
    Chronic osteomyelitis

    THANK
    YOU

    REFERENCES
    Apleys System of Orthopaedics and
    Fractures 9th ed
    Journal of the American Academy of
    Orthopaedic Surgeons 2012; 20:684-693
    Textbook of Disorders and Injuries of the
    Musculoskeletal System 3rd ed, Robert B.
    Salter
    Campbells Operative Orthopaedics 11 th ed
    Miller Review of Orthopaedics 5th ed

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