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
...Pre...
...Pr...
...hat patients with diabetes undergo annual in...
...mend that foot examination include testi...
...ucation of the patients and their fam...
...Th...
We suggest against the routine use of spe...
...ng custom therapeutic footwear in high-risk diabe...
...suggest adequate glycemic control (hemoglobin...
...mend against prophylactic arterial revas...
Assessment
...Asses...
...1. Suggested Frequency for Follow-Up Evaluat...
...Diagnosis...
...atients with a diabetic foot infection (DFI) wi...
...s presenting with a new DFI, we su...
...ose patients who require additional (ie, more s...
...atients with suspected DFO for whom MRI is co...
...at high risk for DFO, we recommend that the diagn...
When bone is débrided to treat osteomyeli...
...patients not undergoing bone débridement, we s...
...Peripheral Arte...
...patients with diabetes have ankle-brachia...
...suggest that patients with diabetes wh...
...recommend that patients with DFU have ped...
...ith DFU who have PAD, we recommend rev...
...hnical and Implementation RemarksPrediction of p...
...gure 1. Hemodynamics and Probabilit...
Treatment
...Treatment
O...
...plantar DFU, we recommend off-loading with...
...with DFU requiring frequent dressing chang...
...against using postoperative shoes or standard o...
...tients with nonplantar wounds, we re...
...igh-risk patients with healed DFU (including thos...
...Wound Car...
...recommend frequent evaluation at 1- to 4-week...
...ommend evaluation for infection on initial...
We suggest that treatment of DFIs should fo...
...end use of dressing products that maintain a...
...ecommend sharp débridement of all devitalized tis...
...ing lack of evidence for superiority of any give...
...DFUs that fail to demonstrate improvement (>50%...
We suggest the use of negative pressure wound t...
...suggest consideration of the use of...
...ideration of living cellular thera...
...suggest consideration of the use of ex...
...with DFU who have adequate perfusion that f...
...Algorithm for Prevention and Care of D...
...le 2. Lower Extremity Threatened Limb (SVS WIfI)...
Guideline Recommendation...