Management of Diabetic Foot
Publication Date: February 1, 2016
Last Updated: March 21, 2022
Prevention
Prevention of Diabetic Foot Ulceration
We recommend that patients with diabetes undergo annual interval foot inspections by physicians (MD, DO, DPM) or advanced practice providers with training in foot care. ( S , C )
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We recommend that foot examination include testing for peripheral neuropathy using the Semmes-Weinstein test. ( S , B )
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We recommend education of the patients and their families about preventive foot care. ( S , C )
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Therapeutic Footwear:
We suggest against the routine use of specialized therapeutic footwear in average-risk diabetic patients. ( W , C )
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We recommend using custom therapeutic footwear in high-risk diabetic patients, including those with significant neuropathy, foot deformities, or previous amputation. ( S , B )
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We suggest adequate glycemic control (hemoglobin A1c <7% with strategies to minimize hypoglycemia) to reduce the incidence of diabetic foot ulcers (DFUs) and infections, with subsequent risk of amputation. ( W , B )
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We recommend against prophylactic arterial revascularization to prevent DFU. ( S , C )
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Assessment
Diagnosis of Diabetic Foot Osteomyelitis (DFO)
In patients with a diabetic foot infection (DFI) with an open wound, we suggest doing a probe to bone (PTB) test to aid in diagnosis. ( W , C )
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In all patients presenting with a new DFI, we suggest that serial plain radiographs of the affected foot be obtained to identify bone abnormalities (deformity, destruction) as well as soft tissue gas and radiopaque foreign bodies. ( W , C )
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For those patients who require additional (ie, more sensitive or specific) imaging, particularly when soft tissue abscess is suspected or the diagnosis of osteomyelitis remains uncertain, we recommend using magnetic resonance imaging (MRI) as the study of choice. ( S , B )
MRI is a valuable tool for diagnosis of osteomyelitis if the PTB test is inconclusive or if the plain film is not useful.
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In patients with suspected DFO for whom MRI is contraindicated or unavailable, we suggest a leukocyte or antigranulocyte scan, preferably combined with a bone scan as the best alternative. ( W , B )
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In patients at high risk for DFO, we recommend that the diagnosis is most definitively established by the combined findings on bone culture and histology. ( S , C )
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When bone is débrided to treat osteomyelitis, we recommend sending a sample for culture and histology. ( S , C )
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For patients not undergoing bone débridement, we suggest that clinicians consider obtaining a diagnostic bone biopsy when faced with diagnostic uncertainty, inadequate culture information, or failure of response to empirical treatment. ( W , C )
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Overview
Title
Management of Diabetic Foot
Authoring Organizations
American Podiatric Medical Association
Society for Vascular Surgery