Diabetes-related foot disease

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

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Evidencia revisada por última vez: 15 Feb 2026

Tema actualizado por última vez: 16 Oct 2025

Diabetes-related foot disease, including ulcers and infections, is a common complication of diabetes mellitus.

The majority of diabetic foot ulcers are caused by repetitive trauma sustained during activity on a structurally abnormal, insensate foot.

Preventing and/or healing ulcers helps prevent bacterial infection and 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 especially if there is any tissue loss, loss of sensation, or signs of peripheral artery disease.

The key principles which form the mainstay of management are wound debridement, wound dressings, pressure offloading, treatment of infection, and treatment of ischemia and restoration of tissue perfusion.

Major amputations (i.e., above the ankle) in ambulatory patients are generally avoided, unless there is extensive infection or gangrene so that reconstruction is either not possible or will not preserve meaningful function in the affected limb.

Definición

The term "diabetes-related foot disease" means disease of the foot in a person with current or previously diagnosed diabetes mellitus, including one or more of the following: peripheral neuropathy, peripheral artery disease, ulcer (i.e., a break in the skin that includes as a minimum the epidermis and part of the dermis), infection (i.e., any soft-tissue or bone infection occurring in the diabetic foot, including osteomyelitis), neuro-osteoarthropathy, gangrene, or amputation.[1][2]

Anamnesis y examen

Principales factores de diagnóstico

history of diabetes mellitus
presence of risk factors
foot ulcer
foot pain
loss of protective sensation
foot deformity
fever or chills

Todos los datos

Otros factores de diagnóstico

malaise
anorexia
foot erythema
edema of foot, ankle, or calf
absent pedal pulses
fluctuance

Todos los datos

Factores de riesgo

sensory neuropathy
previous history of foot ulcer
previous history of amputation
peripheral artery disease (PAD)
end-stage renal disease (ESRD)
foot deformities
limited foot and/or ankle joint mobility
visual impairment
poor glucose control
Charcot’s neuro-osteoarthropathy
obesity
obstructive sleep apnea (OSA)

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

clinical diagnosis

Todos los datos

Pruebas diagnósticas que deben considerarse

CBC
blood glucose level
CRP
erythrocyte sedimentation rate
renal function
microbiologic culture
x-ray foot
ankle/toe pressures and brachial indices
pedal doppler waveforms with pulse volume recordings (PVR)
duplex ultrasound
catheter digital subtraction angiography (DSA)
CT angiography
MR angiography
MRI foot
CT foot
18F-fluorodeoxyglucose (FDG)-PET/CT
99mTc-exametazime hexa methyl propylene amine oxime (HMPAO)-labeled white blood cell scintigraphy
99mTc-labeled ubiquicidin (UBI) SPECT/CT single photon emission computed tomography (SPECT/CT)

Todos los datos

Pruebas emergentes

serum procalcitonin

Algoritmo de tratamiento

Agudo

at initial presentation

En curso

after initial definitive treatment

Colaboradores

Autores

Neal R. Barshes, MD, MPH, FACS

Assistant Professor

Division of Vascular Surgery and Endovascular Therapy

Michael E. DeBakey Department of Surgery

Baylor College of Medicine

Houston

Divulgaciones

NRB is an author of several articles cited in this topic.

Joseph L. Mills Sr, MD

Professor and Chief

Division of Vascular Surgery and Endovascular Therapy

Michael E. DeBakey Department of Surgery

Baylor College of Medicine

Houston

Divulgaciones

JLM has been reimbursed for consulting for AnGes and is an author of several articles cited in this topic.

David G. Armstrong, DPM, MD, PhD

Professor of Surgery and Neurological Surgery

Director of Southwestern Academic Limb Salvage Alliance (SALSA)

Keck School of Medicine of University of Southern California (USC)

Los Angeles

Divulgaciones

DGA is an author of several articles cited in this topic.

Revisores por pares

Professor Vinod Panchbhavi, MD, FACS

Chief, Division of Foot and Ankle Surgery

Director, Foot and Ankle Fellowship Program

Department of Orthopedic Surgery

The University of Texas

Galveston

Divulgaciones

VP declares that he has no competing interests.

Robert Hinchliffe, MD, FRCS

Reader and Honorary Consultant Vascular Surgeon

St George's Vascular Institute

London

Divulgaciones

RH declares that he has no competing interests.

Lee C. Rogers, DPM

Associate Professor of Orthopaedics

University of Texas Health Science Center at San Antonio

San Antonio

Divulgaciones

LR declares that he has no competing interests.

Judith Spratt, DPM

Highly Specialist Podiatrist

Lancashire Care Foundation NHS Trust

Preston

Divulgaciones

JS declares that she has no competing interests.

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Divulgaciones

Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.

Referencias

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Artículos principales

American Diabetes Association. Standards of care in diabetes - 2025. Diabetes Care. 2025 Jan 1;48(Suppl 1):S1-343.Texto completo

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.Texto completo Resumen

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.Texto completo Resumen

Senneville É, Albalawi Z, van Asten SA, et al. IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF/IDSA 2023). Diabetes Metab Res Rev. 2023 Oct 1:e3687.Texto completo Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

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- Nutrition interventions in adults with diabetic foot ulcers
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Diabetes-related foot disease

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Pruebas emergentes

Algoritmo de tratamiento

at initial presentation

after initial definitive treatment

Colaboradores

Autores

Neal R. Barshes, MD, MPH, FACS

Divulgaciones

Joseph L. Mills Sr, MD

Divulgaciones

David G. Armstrong, DPM, MD, PhD

Divulgaciones

Revisores por pares

Professor Vinod Panchbhavi, MD, FACS

Divulgaciones

Robert Hinchliffe, MD, FRCS

Divulgaciones

Lee C. Rogers, DPM

Divulgaciones

Judith Spratt, DPM

Divulgaciones

Agradecimiento de los revisores por pares

Divulgaciones

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales

Guías de práctica clínica

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice