Management of Diabetic Foot

Publication Date: February 1, 2016

Key Points

Key Points

Diabetes is one of the leading causes of chronic disease and limb loss worldwide, currently affecting 382 million people.

Every year, >1 million people with diabetes suffer limb loss as a result of diabetes.

Approximately 80% of diabetes-related lower extremity amputations are preceded by a foot ulcer.

This progression from foot ulcer to amputation lends to several possible steps where intervention based on evidence-based guidelines may prevent major amputation.

Prevention

...reventio...

...of Diabetic Foot Ulceration...

...ommend that patients with diabetes unde...

...d that foot examination include testing for perip...

...nd education of the patients and their famili...

...erapeutic Footwe...

...against the routine use of specializ...

...commend using custom therapeutic footwear in...

...uate glycemic control (hemoglobin A1c...

...mend against prophylactic arterial revascularizat...


Assessment

...ssessment...

...ggested Frequency for Follow-Up Evalua...


...Diabetic Foot Osteomyelitis (DFO)...

...ients with a diabetic foot infection (DFI) with a...

...presenting with a new DFI, we suggest that...

...ents who require additional (ie, more sen...

...tients with suspected DFO for whom MR...

...s at high risk for DFO, we recommend that the dia...

...is débrided to treat osteomyelitis, we recom...

...ients not undergoing bone débridement, we sug...


...al Arterial Disease (PAD) and the DFU...

...t patients with diabetes have ankle-bra...

We suggest that patients with diabetes who hav...

...recommend that patients with DFU ha...

...tients with DFU who have PAD, we rec...


...ical and Implementation RemarksPredi...


...Hemodynamics and Probability of Healing of a...


Treatment

...reatment...

...oading DFUs...

In patients with plantar DFU, we recomme...

...ts with DFU requiring frequent dressing chang...

...suggest against using postoperative shoes or stand...

...nts with nonplantar wounds, we recommend usin...

...-risk patients with healed DFU (includin...


...Care For DFUs...

...nd frequent evaluation at 1- to 4-week in...

...mend evaluation for infection on initial present...

...uggest that treatment of DFIs should follo...

...mmend use of dressing products that maintain...

...recommend sharp débridement of all devital...

...of evidence for superiority of any given...

...fail to demonstrate improvement (...

...the use of negative pressure wound therapy for c...

We suggest consideration of the use of PDGF (bec...

...suggest consideration of living cell...

...onsideration of the use of extracellular matrix...

...patients with DFU who have adequate p...


...gure 2. Algorithm for Prevention and Care of...


Table 2. Lower Extremity Threatened Li...


...ecommendation Highlights