Summary
Definition
History and exam
Key diagnostic factors
- history of diabetes mellitus
- foot ulcer
- foot pain
- fever or chills
Other diagnostic factors
- malaise
- anorexia
- foot erythema
- edema of foot, ankle, or calf
- absent pedal pulses
- fluctuance
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
Diagnostic investigations
1st investigations to order
- CBC
- blood glucose level
- x-ray foot
Investigations to consider
- microbiologic culture
- renal function
- ankle/toe pressures
- angiography
- MRI foot
Emerging tests
- CT angiography
- erythrocyte sedimentation rate
- CRP
Treatment algorithm
at initial presentation
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, 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
Associate Professor of Orthopaedics
University of Texas Health Science Center at San Antonio
San Antonio
TX
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.
Differentials
- Venous leg ulcer
- Gout
- Acute Charcot arthropathy
More DifferentialsGuidelines
- Standards of care in diabetes - 2023
- Nutrition interventions in adults with diabetic foot ulcers
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