Diabetic foot complications

Last reviewed: 26 Aug 2022
Last updated: 30 Mar 2022

Summary

Definition

History and exam

Key diagnostic factors

  • history of diabetes mellitus
  • foot ulcer
  • foot pain
  • fever or chills
More key diagnostic factors

Other diagnostic factors

  • malaise
  • anorexia
  • foot erythema
  • edema of foot, ankle, or calf
  • absent pedal pulses
  • fluctuance
Other diagnostic factors

Risk factors

  • 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
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC
  • blood glucose level
  • x-ray foot
More 1st investigations to order

Investigations to consider

  • microbiologic culture
  • renal function
  • ankle/toe pressures
  • angiography
  • MRI foot
More investigations to consider

Emerging tests

  • CT angiography
  • erythrocyte sedimentation rate
  • CRP

Treatment algorithm

ACUTE

at initial presentation

ONGOING

after initial definitive treatment

Contributors

Authors

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

TX

Disclosures

NRB declares that he has no competing interests.

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

TX

Disclosures

JLM declares that he has no competing interests.

David G. Armstrong, DPM, MD, PhD

Professor of Surgery

Director of Southwestern Academic Limb Salvage Alliance (SALSA)

Department of Surgery

Keck School of Medicine of University of Southern California

Los Angeles

CA

Disclosures

DGA declares that he has no competing interests.

Peer reviewers

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

TX

Disclosures

VP declares that he has no competing interests.

Robert Hinchliffe, MD, FRCS

Reader and Honorary Consultant Vascular Surgeon

St George's Vascular Institute

London

UK

Disclosures

RH declares that he has no competing interests.

Lee Rogers, DPM

Executive Medical Director/Podiatrist

Amputation Prevention Center

Los Angeles

CA

Disclosures

LR declares that he has no competing interests.

Judith Spratt, DPM

Highly Specialist Podiatrist

Lancashire Care Foundation NHS Trust

Preston

UK

Disclosures

JS declares that she has no competing interests.

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