Management of Diabetic Foot
Key Points
Key Points
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
...evention
...of Diabetic Foot Ulceration...
...hat patients with diabetes undergo annual...
We recommend that foot examination include te...
...cation of the patients and their families about pr...
...rapeutic Footwear:...
...est against the routine use of special...
...nd using custom therapeutic footwear in...
...ate glycemic control (hemoglobin A1c...
...ainst prophylactic arterial revascularizatio...
Assessment
...sessment...
...ted Frequency for Follow-Up EvaluationHaving tr...
...iabetic Foot Osteomyelitis (DFO)...
...n patients with a diabetic foot infection (DF...
...ll patients presenting with a new...
...ents who require additional (ie, more sensitive...
...patients with suspected DFO for whom...
...atients at high risk for DFO, we recomm...
When bone is débrided to treat osteomyelitis,...
...r patients not undergoing bone débridem...
...pheral Arterial Disease (PAD) and the DF...
...gest that patients with diabetes have ank...
...t patients with diabetes who have a prior h...
...nd that patients with DFU have pedal perfusion...
...ts with DFU who have PAD, we recommend revas...
...nd Implementation RemarksPrediction o...
...e 1. Hemodynamics and Probability of...
Treatment
...atment
...Loading DFUs...
...s with plantar DFU, we recommend off-loadi...
...DFU requiring frequent dressing changes,...
...st using postoperative shoes or standard or custo...
...n patients with nonplantar wounds, we r...
...atients with healed DFU (including those wi...
...nd Care For DFUs...
...recommend frequent evaluation at 1- to 4-...
We recommend evaluation for infect...
...ggest that treatment of DFIs should follow the...
We recommend use of dressing products...
We recommend sharp débridement of...
...lack of evidence for superiority of any give...
...DFUs that fail to demonstrate improv...
...ggest the use of negative pressure wound therapy f...
...consideration of the use of PDGF (becaplermin) for...
...gest consideration of living cellular therapy usin...
...ideration of the use of extracellu...
...ients with DFU who have adequate perfusion...
...2. Algorithm for Prevention and Care of Diabetic...
Table 2. Lower Extremity Threatened Limb (SV...
...Recommendation Highlight...