Firstly, Risk Assessment:
- peripheral neuropathy
- peripheral vascular disease
- previous ulceration
- foot deformity
- poor glycaemic control
- absence of footcare education
- low SES
If low risk foot
- General foot care and advice
- Annual review (use monofilament)
If “At risk” foot i.e. neuropathy, absent pulses, or other risk factor
Conservative:
Education about the risk of foot problems,
Advise patient about daily inspection
Foot protection - avoidance of walking on bare foot, wearing of well fitting footware and loose cotton socks
If there is Ulcer -As above with :
Conservative:
Education about the risk of foot problems,
Advise patient about daily inspection
Foot protection - avoidance of walking on bare foot, wearing of well fitting footware and loose cotton socks
Medical: IV antibiotics
Surgical:
Wound debridement
Evaluate patient for PVD with ABI
Evaluate bone involvement if bone seen or easily detected by probing or if ulcer depth is more than 3mm and ESR more than 40
X ray
Bone scan
MRI ( 98 % sensitivity and 81 % specificity )
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I had my TL a little more than a year ago when my third child was born via c-section. I was not told ANYTHING about the possible side effects of having this procedure. Since then I have experienced heavy bleeding lasting sometimes 3 weeks out of the month, weight gain, severe mood swings. Severe cramping, changes to my libido, severe depression accompanied by suicidal thoughts, headaches, migraines, many new symptoms & older issues are now exacerbated. The father of two of my children doesn't want me anymore. I've become too much of a pain in the ass I guess. We don't talk. We don't sleep in the same bed. I think he might really think I am crazy... & maybe I am. I feel crazy a lot of the time.
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