N

nail (metal), penetrating shoe 37,44 see also puncture wounds nail bed, colour 4,5 nails common problems 19 cutting own 19,32-3 examination 4-5 infections 5,22 ingrowing 4,20-1 involuted 21—2 lesions under 5,23 neuroischaemic ulcers under 75 self care 32-3 structure 4

surgical avulsion 20,21,22 natural history of diabetic foot 13 necrobiosis lipoidica diabeticorum (NLD) 3,4 necrosis (gangrene) 8,63,141 causes 141-3

cellulitis with subcutaneous 107-9,124-7,

129-30 dry 143,144-9

acute ischaemia 145-6,147 emboli to toes 146-8 management 150-1 microbiological control 163 severe chronic ischaemia 144-5 vascular control 163-5 early signs 141

henna masquerading as 168-9 in neuroischaemic foot see under neuroischaemic foot in neuropathic foot see under neuropathic foot overwhelming 173-4 patient's fears 169

in remaining limb of amputees 179—80 in renal impairment 141-2,148—50 subungual 23

treatment techniques 152-62 wet 142-3

management 150,151 microbiological control 162-3 in neuroischaemic foot 144 in neuropathic foot 144,145 wound control 151-2,154 necrotic foot (stage 5) 13,15,141-72 educational control 168—71 management 15,150-71 mechanical control 165-8 metabolic control 168 microbiological control 162-3 presentation and diagnosis 141-50 vascular control 163-5 wound control 151-62 necrotizing fasciitis 157-9 needles, insulin 93-4 Neoprene 72

neuroischaemic foot 12-13,65 arterial bypass surgery 85 bullae 88,89 callus 40 footwear 36 infected 13,14 with blue/black discolouration 124-7 clinical presentations 105 - 6 differential diagnosis 43,110-11

microbiological control 117,119-20,121-7 surgical debridement 130-3 vascular control 133-5 wound care 129,130,131 metabolic control 135 necrosis 13,15,144-9 dry see necrosis, dry management 150-1 mechanical control 166-7 microbiological control 163 vascular control 163-5 wet 144,146

wound control 151-2,153-60 neuropathic foot developing into 155-9 non-ulcerative complications 35,42-4 pain control 84-5 ulcerated see neuroischaemic ulcers unsalvageable 173-4 neuroischaemic ulcers 62,63 debridement 75 examination 63-4 mechanical control 72-3 microbiological control 80,81 subungual 75 vascular control 81-5 wound control 73-80 neurological assessment 9-10 neurological investigations 11 neuropathic foot 12,65 assessment 3,9-10 becoming neuroischaemic 155-9 bullae 88,89 callus 40 infected 13,14

clinical presentations 104,105-9 management 117-19,120-1,124 surgical debridement 128-9,130-3 investigations 11 necrosis 144,145,150 mechanical control 165 wound control 151,152-3,154-9 painful see painful neuropathy specific non-ulcerative complications 48-60

ulcers see neuropathic ulcers unsalvageable 174 neuropathic fractures 50-1,65 neuropathic oedema 5,44 neuropathic ulcers 12,62-3 debridement 73-5 examination 63-4 mechanical control 66-72 microbiological control 80,81 wound control 73-80 neurothesiometer 11 normal foot (stage 1) 13,17-34 educational control 31-3 elective surgery 184 management 15,17-33 mechanical control 18-29 metabolic control 29-31 presentation and diagnosis 17 numbness 2 nutrition 168,184

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