Diabetes-related foot disease

概述 
理论 
诊断 
治疗 
随访 
资源 

最后审阅： 10 Oct 2025

最后更新： 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.

定义

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]

病史和体格检查

关键诊断因素

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

完整详情

其他诊断因素

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

完整详情

危险因素

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)

完整详情

诊断性检查

首要检查

clinical diagnosis

完整详情

需考虑的检查

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)

完整详情

新兴检查

serum procalcitonin

治疗流程

急症处理

at initial presentation

持续性治疗

after initial definitive treatment

撰稿人

作者

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

利益声明

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

利益声明

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

利益声明

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

同行评议者

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

利益声明

VP declares that he has no competing interests.

Robert Hinchliffe, MD, FRCS

Reader and Honorary Consultant Vascular Surgeon

St George's Vascular Institute

London

利益声明

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

利益声明

LR declares that he has no competing interests.

Judith Spratt, DPM

Highly Specialist Podiatrist

Lancashire Care Foundation NHS Trust

Preston

利益声明

JS declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

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

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.全文摘要

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.全文摘要

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.全文摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断
- Venous leg ulcer
- Gout
- Acute Charcot neuro-osteoarthropathy
更多鉴别诊断
指南
- ACR appropriateness criteria: suspected osteomyelitis of the foot in patients with diabetes mellitus
- Nutrition interventions in adults with diabetic foot ulcers
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Diabetes-related foot disease

小结

定义

病史和体格检查

关键诊断因素

其他诊断因素

危险因素

诊断性检查

首要检查

需考虑的检查

新兴检查

治疗流程

at initial presentation

after initial definitive treatment

撰稿人

作者

Neal R. Barshes, MD, MPH, FACS

利益声明

Joseph L. Mills Sr, MD

利益声明

David G. Armstrong, DPM, MD, PhD

利益声明

同行评议者

Professor Vinod Panchbhavi, MD, FACS

利益声明

Robert Hinchliffe, MD, FRCS

利益声明

Lee C. Rogers, DPM

利益声明

Judith Spratt, DPM

利益声明

Peer reviewer acknowledgements

Disclosures

参考文献

关键文献

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断

指南

登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

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