Diabetic Foot — Vascular Component

Diabetic foot disease combines: • Peripheral neuropathy (most common) — loss of sensation, motor, autonomic. • Peripheral arterial disease (PAD) — ischaemia. • Infection. Vascular assessment essential in all diabetic foot disease + ulceration. • Examination: pedal pulses (DP, PT), capillary refill, skin colour, temperature, hair loss, ulcer location (neuropathic — pressure points; ischaemic — toes, heels, lateral foot). • Ankle-brachial pressure index (ABPI): often falsely elevated in diabetes (medial arterial calcification — 'pipe stem' arteries) — TBPI more reliable. • Toe brachial pressure index (TBPI): <0.7 abnormal. • Transcutaneous oxygen tension (TcPO₂): <30 mmHg significant ischaemia. • Doppler USS waveforms. • Refer to multidisciplinary foot team within 24h (NICE NG19).