Diabetic foot complications, including ulcers and infections, are 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.
The term "diabetic foot complications" encompasses the conditions of diabetic foot ulcer (i.e., a break in the skin that includes as a minimum the epidermis and part of the dermis and occurs below/distal to the malleoli in a person with diabetes) and diabetic foot infections (i.e., any soft-tissue or bone infection occurring in the diabetic foot, including osteomyelitis).
History and exam
Key diagnostic factors
- history of diabetes mellitus
- foot ulcer
- foot pain
- fever or chills
Other diagnostic factors
- foot erythema
- edema of foot, ankle, or calf
- absent pedal pulses
- sensory neuropathy
- previous history of foot ulcer
- previous history of partial foot (toe) amputation
- Charcot midfoot deformity
- peripheral artery disease (PAD)
- end-stage renal disease
- structural forefoot deformities
- limited ankle joint mobility (ankle equinus)
- visual impairment
- poor glucose control
1st investigations to order
- blood glucose level
- x-ray foot
Investigations to consider
- microbiologic culture
- renal function
- ankle/toe pressures
- MRI foot
- CT angiography
- erythrocyte sedimentation rate
at initial presentation
after initial definitive treatment
- Venous leg ulcer
- Acute Charcot arthropathy
- Standards of care in diabetes - 2023
- Nutrition interventions in adults with diabetic foot ulcers
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer