Diabetes-related foot disease

Diabetes-related foot disease, including ulcers and infections, is 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 "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