Diabetic foot complications

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).[1]van Netten JJ, Bus SA, Apelqvist J, et al; International Working Group on the Diabetic Foot. Definitions and criteria for diabetic foot disease. Diabetes Metab Res Rev. 2020 Mar;36 Suppl 1:e3268. https://onlinelibrary.wiley.com/doi/10.1002/dmrr.3268 http://www.ncbi.nlm.nih.gov/pubmed/31943705?tool=bestpractice.com