tailieunhanh - Atlas of the Diabetic Foot - part 4

Các ngón chân Claw, onychomycosis và da khô cũng có mặt. Chai đã được gỡ bỏ, và một bề mặt loét nhỏ tiết lộ. Bệnh nhân được quy định giày sâu thêm với lót dụng cụ chỉnh hình (phòng ngừa giày dép). Kem dưỡng ẩm được sử dụng để ngăn ngừa nứt da. | 64 Atlas of the Diabetic Foot Figure Callus over prominence of metatarsal head from retinopathy or nephropathy but he had severe diabetic neuropathy. On examination a callus was present under the head of his right third metatarsal which caused minor discomfort Figure . Another bony prominence was evident on the outer aspect of his fifth metatarsal without callus formation. Claw toes onychomycosis and dry skin were also present. The callus was removed and a tiny superficial ulcer revealed. The patient was prescribed extra depth shoes with orthotic insoles preventive footwear . Hydrating cream was used to prevent skin cracking. Keywords Callus claw toes dry skin CALLUS OVER PROMINENT METATARSAL HEADS A 70-year-old female patient who had type 2 diabetes since the age of 50 years and was being treated with insulin attended the foot clinic for chiropody treatment. She had a history of ischemic heart disease myocardial infarction and stroke peripheral vascular disease treated with low dose Anatomical Risk Factors for Diabetic Foot Ulceration 65 of aspirin and proliferative retinopathy. She complained of numbness in both feet and a deep aching pain in her calves and painful heel cracks. On examination peripheral pulses were absent and her ankle brachial index was on the left and on the right. The vibration perception threshold was 30 V in both feet. Achilles tendon reflexes were absent and pain temperature light touch and vibration sensation were severely diminished. Pes cavus and hallux valgus were present on both feet most prominent on the left together with an obvious prominence of her metatarsal heads and callus formation. The fat pads of her metatarsal heads were translocated towards the toes. The skin on her feet was dry Figure . The calluses were debrided on a regular basis and appropriate footwear was prescribed. Heel cracks see Figure persisted despite debridement. Calluses develop in areas of high pressure in the feet as a .