By Michael E. Edmonds, Alethea V. M. Foster, Lee Sanders
3rd writer, Lee. J. Sanders, is the dep. of Veterans Affairs scientific middle, Lebanon, PA. deals sensible and medical suggestion at the administration of long term foot difficulties in individuals with diabetes. Discusses prognosis and therapy, either clinical and surgical. top of the range colour pictures illustrated a number of the problems. DNLM: Diabetic Foot--diagnosis.
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Pedal bullae are sometimes associated with hypoglycaemic episodes. Several serious lesions, including early neuropathic and early ischaemic ulcers, pressure ulcers, burns, puncture wounds and infections complicating ulceration, may first present as a bulk. Unless bullae are small, superficial and containing clear fluid, they should be regarded as stage 3 lesions. Small, flaccid bullae can be cleaned and covered with a sterile non-adherent dressing. Large bullae (over 1 cm in diameter) and all tense bullae should be lanced with a scalpel and drained before dressing.
The treatment is surgical. Fungal infections (tinea pedis) These can present in several ways: • Dry, scaly plantar, often in a 'moccasin-like' distribution • Acute vesicular • Interdigital, with moist, cracked areas which may be sore, itchy and sometimes malodorous, and are associated with whitish, rubbery, macerated skin, and can undergo erosion. (b) 24 Chapter 2 Fig. 10 An area of thickened rubbery white skin between the toes (tinea pedis). Fig. 9 Amelanotic melanoma. Scrapings can be taken and sent to the laboratory for identification of the infective organism but usually a clinical diagnosis is made.
Malignant melanoma may also present as a discoloured area under the nail plate. Irregular discolouration of the nail bed and plate and progressive destruction of nail are seen. Some melanomas are not associated with pigment (Fig. 9). Patients should be referred urgently to the dermatologist. Subungual exostosis. An acutely painful cherry red spot develops under the nail plate. A lateral X-ray reveals bony outgrowth of the distal phalanx. The treatment is surgical. Fungal infections (tinea pedis) These can present in several ways: • Dry, scaly plantar, often in a 'moccasin-like' distribution • Acute vesicular • Interdigital, with moist, cracked areas which may be sore, itchy and sometimes malodorous, and are associated with whitish, rubbery, macerated skin, and can undergo erosion.
A Practical Manual of Diabetic Foot Care by Michael E. Edmonds, Alethea V. M. Foster, Lee Sanders