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

...vention

...ention of Diabetic Foot Ulceration...

...t patients with diabetes undergo annual in...

...recommend that foot examination include testing f...

...recommend education of the patients and their fa...

Therapeutic Footwe...

...nst the routine use of specialized the...

...using custom therapeutic footwear in high-ri...

...t adequate glycemic control (hemoglobin A...

...recommend against prophylactic ar...


Assessment

...essment

...1. Suggested Frequency for Follow-Up Evaluation...


...gnosis of Diabetic Foot Osteomyelitis...

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

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

...ose patients who require additional (ie, more...

...suspected DFO for whom MRI is contraindicated...

...igh risk for DFO, we recommend that the...

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

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


...ral Arterial Disease (PAD) and the...

...hat patients with diabetes have ankle-b...

...that patients with diabetes who have a...

...at patients with DFU have pedal perfusion...

...atients with DFU who have PAD, we recommend rev...


...l and Implementation RemarksPrediction of pat...


...1. Hemodynamics and Probability of...


Treatment

...eatment

...Loading DFUs...

...patients with plantar DFU, we recom...

...with DFU requiring frequent dressing...

We suggest against using postoperative s...

...nonplantar wounds, we recommend using any modal...

...igh-risk patients with healed DFU (in...


...Care For DFUs...

...recommend frequent evaluation at 1- to 4-w...

...luation for infection on initial presen...

...ggest that treatment of DFIs should follow th...

...mmend use of dressing products tha...

...end sharp débridement of all devitalized t...

...of evidence for superiority of any g...

...fail to demonstrate improvement (>50% wound a...

...st the use of negative pressure wo...

...nsideration of the use of PDGF (bec...

...e suggest consideration of living c...

...deration of the use of extracellular...

...with DFU who have adequate perfusion that fa...


...rithm for Prevention and Care of Diabetic...


Table 2. Lower Extremity Threatened Limb (SVS...


...Recommendation Highlights...