Highlights & Basics
- Diabetes-related foot disease, including ulcers and infections, is a common and costly complication of diabetes mellitus.
- The majority of diabetic foot ulcers are caused by repetitive trauma sustained during activity on a structurally abnormal, insensate foot.
- Ulcers act as a portal of entry for bacterial infections. Preventing and/or healing ulcers helps prevent infections and thereby minimizes risk of limb loss.
- Initial evaluation and early management may be by primary care providers; however, there should be a low threshold to refer to an interdisciplinary diabetic foot care clinic or inpatient unit. This is particularly true if there is any a) tissue loss b) loss of sensation or c) signs of peripheral artery disease.
- Leg amputation should be avoidable in the majority of cases and is rarely the first-choice option for ambulatory patients.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Midfoot ulcer in a patient with Charcot neuro-osteoarthropathy (midfoot collapse)
Uninfected foot ulcer overlying the plantar aspect of the first metatarsophalangeal joint. Note the hyperkeratotic skin (callus) surrounding the wound edge
A foot infection originating from a gangrenous third toe. Note the erythema and fluctuance in the midfoot. An abscess cavity was found tracking under the longitudinal section of macerated skin
Diabetic foot problems can be related to the presence of a wound, ischemia, or infection (WIfI). Which of these parameters is dominant may vary, and a flexible long-term management approach is needed. The Venn diagram shows intersecting rings of dominance for these three parameters, with gradings listed for each. The shaded areas represent combinations of these parameters of dominance
Citations
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Schaper NC, van Netten JJ, Apelqvist J, et al. Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update). Diabetes Metab Res Rev. 2024 Mar;40(3):e3657.[Abstract][Full Text]
Mills JL Sr, Conte MS, Armstrong DG, et al; Society for Vascular Surgery Lower Extremity Guidelines Committee. The Society for Vascular Surgery lower extremity threatened limb classification system: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg. 2014 Jan;59(1):220-34.[Abstract][Full Text]
Boulton AJ, Armstrong DG, Kirsner RS, et al; American Diabetes Association. Diagnosis and management of diabetic foot complications. 2018 [internet publication].[Full Text]
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