# Diabetic Foot Pathway: From Callus to Amputation
> A clinical guide for healthcare professionals on diabetic foot management, covering neuropathy, ulcer classification, osteomyelitis, and MDT care.

Tags: diabetes, foot-care, wound-management, podiatry, nursing, diabetic-ulcer, healthcare-education
## Diabetic Foot Overview
* 15% of diabetic patients develop foot ulcers.
* 85% of major lower extremity amputations are preceded by non-healing ulcers.
* Risk Triad: Neuropathy, Ischemia, and Infection.

## Pathophysiology
* **Peripheral Neuropathy:** Loss of protective sensation, motor deformity, and autonomic skin changes.
* **Peripheral Arterial Disease:** Reduced blood flow impairing wound healing.
* **Immunopathy:** Impaired inflammatory response due to hyperglycemia.

## Callus and Ulcer Classification
* **Callus:** Pre-ulcerative lesion that increases plantar pressure by 30%.
* **Wagner Grade System (0-5):** Ranges from pre-ulcerative lesions to superficial ulcers, deep infection, and gangrene.
* **Assessment Pillars:** Wound size, depth, infection signs, vascularity, and sensation.

## Clinical Complications
* **Infection:** Often polymicrobial; neuropathy may mask classic pain symptoms.
* **Osteomyelitis:** Bone infection typically spread from soft tissue; MRI is gold standard for diagnosis.
* **Vascular:** Critical Limb Ischemia (CLI) requires immediate referral for revascularization.

## Management and Prevention
* **Multidisciplinary Team (MDT):** Includes podiatrists, diabetologists, surgeons, nurses, and GPs.
* **Amputation:** Levels range from toe/ray (minor) to below/above knee (major).
* **Prevention Strategy:** Annual screening, patient education, glycemic control, and offloading footwear.
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