Diabetes-related foot disease

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

Most 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 minimises risk of limb loss.

Prevention and identification may be by primary care physicians; however, UK guidance recommends referring all patients with active foot problems to a multidisciplinary diabetic foot care clinic or inpatient unit.

Antibiotics are recommended for management of infection, with associated drainage/debridement of any ongoing deep soft-tissue infection. Amputation is typically reserved for gangrene, loss of limb function, and severe non-reconstructable peripheral arterial disease.

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]van Netten JJ, Bus SA, Apelqvist J, et al. Definitions and criteria for diabetes-related foot disease (IWGDF 2023 update). Diabetes Metab Res Rev. 2024 Mar;40(3):e3654. https://onlinelibrary.wiley.com/doi/10.1002/dmrr.3654 http://www.ncbi.nlm.nih.gov/pubmed/37186781?tool=bestpractice.com ​​​​​[2]Armstrong DG, Tan TW, Boulton AJM, et al. Diabetic foot ulcers: a review. JAMA. 2023 Jul 3;330(1):62-75. http://www.ncbi.nlm.nih.gov/pubmed/37395769?tool=bestpractice.com