Ulcers (wounds) involving the feet and toes are most commonly seen in diabetic patients and are commonly called diabetic foot ulcers (DFUs). Similar wounds are also seen in older patients with peripheral arterial disease (PAD), end stage renal disease (ESRD) and other conditions.
These wounds generally fall into 3 categories, neuropathic, neuroishcemic and ischemic.
Whenever presented with a foot wound we need to determine whether or not there is an ischemic component to that wound. Clinical evaluation has shown to be limited this regard. Patients with palpable pulses still may have significant foot ischemia. Objective testing using skin perfusion pressures or toe brachial index (TBI) is required.
Too often patients with an ischemic component to their ulcer do not undergo physiologic evaluation to see if they would benefit from revascularization. In fact, many patients end up with an amputation as their first procedure. It is absolutely paramount that all patients with a non-ulcer be seen by an expert in evaluating patients for critical limb ischemia before there undergo an amputation.
Peripheral arterial disease (PAD) and its more severe variant critical limb ischemia (CLI) can be notoriously difficult to diagnose.
It is important to recognize that there are 2 types of PCS, primary and secondary as their treatments differ.