Skip to main content

Diabetic Foot

  • Chapter
  • First Online:
Vascular Diseases for the Non-Specialist

Abstract

The diabetic foot is defined as the presence of ulcer, infection, or deep tissue breakdown in a foot of a person with diabetes, in association with peripheral neuropathy and/or peripheral arterial disease. Diabetic foot ulcers, the leading cause of diabetic patients’ hospitalization, are among the most common, serious, and costly complications of diabetes mellitus and results in major consequences for patients, their families and society. The pathophysiologic background consists in a neuropathic foot, with the loss of protective sensation, leaving the foot vulnerable to repetitive trauma. Furthermore, the association of vascular disease and the predisposition to infection completes the triad which ultimately leads to amputation. The management of diabetic foot is complex and requires a multidisciplinary approach. Once established, it is a marker of poor limb prognosis, and, as always, the prevention is the most effective strategy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cavanagh PR, Lipsky BA, Bradbury AW, Botek G. Treatment for diabetic foot ulcers. Lancet. 2005;366(9498):1725–35.

    Article  PubMed  Google Scholar 

  2. Alexiadou K, Doupis J. Management of diabetic foot ulcers. Diabetes Ther. 2012;3(1):1–15.

    Article  Google Scholar 

  3. Boulton AJ. The diabetic foot: grand overview, epidemiology and pathogenesis. Diabetes Metab Res Rev. 2008;24(S1):S3–6.

    Article  PubMed  Google Scholar 

  4. Nouvong A, Armstrong DG. Diabetic foot ulcers. In: Cronenwett JL, Johnston KW, editors. Rutherford’s vascular surgery. 8th ed. Philadelphia: Elsevier Saunders; 2014. p. 1816–35.

    Google Scholar 

  5. Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366(9498):1719–24.

    Article  PubMed  Google Scholar 

  6. Hinchliffe RJ, Brownrigg JR, Apelqvist J, Boyko EJ, Fitridge R, Mills JL, et al. IWGDF guidance on the diagnosis, prognosis and management of peripheral artery disease in patients with foot ulcers in diabetes. Diabetes Metab Res Rev. 2016;32 Suppl 1:37–44.

    Article  PubMed  Google Scholar 

  7. Apelqvist J, Bakker K, Van Houtum W, Nabuurs‐Franssen M, Schaper N. International consensus and practical guidelines on the management and the prevention of the diabetic foot. Diabetes Metab Res Rev. 2000;16(S1):S84–92.

    Article  PubMed  Google Scholar 

  8. Hingorani A, LaMuraglia GM, Henke P, Meissner MH, Loretz L, Zinszer KM, et al. The management of diabetic foot: a clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. J Vasc Surg. 2016;63(2):3S–21.

    Article  PubMed  Google Scholar 

  9. Miller JD, Carter E, Shih J, Giovinco NA, Boulton AJ, Mills JL, et al. How to do a 3-minute diabetic foot exam. J Fam Pract. 2014;63(11):646–56.

    PubMed  Google Scholar 

  10. Apelqvist J, Larsson J. What is the most effective way to reduce incidence of amputation in the diabetic foot? Diabetes Metab Res Rev. 2000;16(S1):S75–83.

    Article  PubMed  Google Scholar 

  11. Driver VR, Fabbi M, Lavery LA, Gibbons G. The costs of diabetic foot: the economic case for the limb salvage team. J Vasc Surg. 2010;52(3):17S–22.

    Article  PubMed  Google Scholar 

  12. Júnior A, do Amaral LAH, Bastos MG, do Nascimento LC, Alves MJM, de Andrade MAP. Prevention of lower-limb lesions and reduction of morbidity in diabetic patients. Rev Bras Ortop. 2014;49(5):482–7.

    Article  Google Scholar 

  13. Mazlina M, Shamsul A, Jeffery FS. Health-related quality of life in patients with diabetic foot problems in Malaysia. Med J Malaysia. 2011;66(3):234–8.

    CAS  PubMed  Google Scholar 

  14. Gerrits EG, Landman GW, Nijenhuis-Rosien L, Bilo HJ. Limited joint mobility syndrome in diabetes mellitus: a minireview. World J Diabetes. 2015;6(9):1108.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Armstrong DG, Wrobel J, Robbins JM. Guest Editorial: are diabetes-related wounds and amputations worse than cancer? Int Wound J. 2007;4(4):286–7.

    Article  PubMed  Google Scholar 

  16. Izumi Y, Satterfield K, Lee S, Harkless LB. Risk of reamputation in diabetic patients stratified by limb and level of amputation: a 10-year observation. Diabetes Care. 2006;29(3):566–70.

    Article  PubMed  Google Scholar 

  17. Margolis D, Malay D, Hoffstad O, Leonard C, MaCurdy T, de Nava K, et al. Incidence of diabetic foot ulcer and lower extremity amputation among Medicare beneficiaries, 2006 to 2008. In: Rockville M, editor. Data points publication series, 10. Pennsylvania; 2011.

    Google Scholar 

  18. Markakis K, Bowling F, Boulton A. The diabetic foot in 2015: an overview. Diabetes Metab Res Rev. 2016;32 Suppl 1:169–78.

    Article  PubMed  Google Scholar 

  19. Hobizal KB, Wukich DK. Diabetic foot infections: current concept review. Diabet Foot Ankle. 2012;3.

    Google Scholar 

  20. Fernando M, Crowther R, Lazzarini P, Sangla K, Cunningham M, Buttner P, et al. Biomechanical characteristics of peripheral diabetic neuropathy: a systematic review and meta-analysis of findings from the gait cycle, muscle activity and dynamic barefoot plantar pressure. Clin Biomech. 2013;28(8):831–45.

    Article  Google Scholar 

  21. Hinchliffe R, Brownrigg J, Andros G, Apelqvist J, Boyko E, Fitridge R, et al. Effectiveness of revascularisation of the ulcerated foot in patients with diabetes and peripheral artery disease: a systematic review. Diabetes Metab Res Rev. 2016;32 Suppl 1:136–44.

    Article  PubMed  Google Scholar 

  22. Frykberg RG, Belczyk R. Epidemiology of the Charcot foot. Clin Podiatr Med Surg. 2008;25(1):17–28. v.

    Article  PubMed  Google Scholar 

  23. Rajbhandari SM, Jenkins RC, Davies C, Tesfaye S. Charcot neuroarthropathy in diabetes mellitus. Diabetologia. 2002;45(8):1085–96.

    Article  CAS  PubMed  Google Scholar 

  24. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33(1):S1–75.

    Article  PubMed  Google Scholar 

  25. Mills Sr J. Lower limb ischemia in patients with diabetic foot ulcers and gangrene: recognition, anatomic patterns and revascularization strategies. Diabetes Metab Res Rev. 2016;S1:239–45.

    Article  Google Scholar 

  26. Mills Sr JL, Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg. 2014;59(1):220–34.e1–2.

    Google Scholar 

  27. Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendel CS, Lipsky BA. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006;29(6):1288–93.

    Article  PubMed  Google Scholar 

  28. Wagner Jr FW. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle. 1981;2(2):64–122.

    Article  PubMed  Google Scholar 

  29. Game FL, Apelqvist J, Attinger C, Hartemann A, Hinchliffe RJ, Londahl M, et al. Effectiveness of interventions to enhance healing of chronic ulcers of the foot in diabetes: a systematic review. Diabetes Metab Res Rev. 2016;32 Suppl 1:154–68.

    Article  PubMed  Google Scholar 

  30. Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54(12):e132–73.

    Article  PubMed  Google Scholar 

  31. Yotsu RR, Pham NM, Oe M, Nagase T, Sanada H, Hara H, et al. Comparison of characteristics and healing course of diabetic foot ulcers by etiological classification: neuropathic, ischemic, and neuro-ischemic type. J Diabetes Complications. 2014;28(4):528–35.

    Article  PubMed  Google Scholar 

  32. Bakker K, Apelqvist J, Lipsky B, Van Netten J, Schaper N. The 2015 IWGDF guidance documents on prevention and management of foot problems in diabetes: development of an evidence‐based global consensus. Diabetes Metab Res Rev. 2016; 32:2–6.

    Google Scholar 

  33. Pham H, Armstrong DG, Harvey C, Harkless LB, Giurini JM, Veves A. Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. Diabetes Care. 2000;23(5):606–11.

    Article  CAS  PubMed  Google Scholar 

  34. Young M, Boulton A, MacLeod A, Williams D, Sonksen P. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993;36(2):150–4.

    Article  CAS  PubMed  Google Scholar 

  35. American Diabetes Association. (9) Microvascular complications and foot care. Diabetes Care. 2015;38 Suppl 1:S58–66.

    Article  Google Scholar 

  36. Bus S, Deursen R, Armstrong D, Lewis J, Caravaggi C, Cavanagh P. Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review. Diabetes Metab Res Rev. 2016;32:99–118.

    Google Scholar 

  37. Boulton AJ, Armstrong DG, Albert SF, Frykberg RG, Hellman R, Kirkman MS, et al. Comprehensive foot examination and risk assessment. A report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Phys Ther. 2008;88(11):1436–43.

    PubMed  Google Scholar 

  38. Bergin S, Gurr J, Allard B, Holland E, Horsley M, Kamp M, et al. Australian Diabetes FootNetwork: management of diabetes-related foot ulceration—a clinical update. Med J Aust. 2012;197(4):226–9.

    Article  PubMed  Google Scholar 

  39. Hingorani A, LaMuraglia GM, Henke P, Meissner MH, Loretz L, Zinszer KM, et al. The management of diabetic foot: a clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. J Vasc Surg. 2016;63(2 Suppl):3S–21.

    Article  PubMed  Google Scholar 

  40. Federman DG, Ladiiznski B, Dardik A, Kelly M, Shapshak D, Ueno CM, et al. Wound healing society 2014 update on guidelines for arterial ulcers. Wound Repair Regen. 2016;24(1):127–35.

    Article  PubMed  Google Scholar 

  41. Dumville JC, Hinchliffe RJ, Cullum N, Game F, Stubbs N, Sweeting M, et al. Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus. Cochrane Database Syst Rev. 2013;10:CD010318.

    Google Scholar 

  42. Dumville JC, O’Meara S, Deshpande S, Speak K. Hydrogel dressings for healing diabetic foot ulcers. Cochrane Database Syst Rev. 2013;7:CD009101.

    Google Scholar 

  43. Dumville JC, Deshpande S, O’Meara S, Speak K. Hydrocolloid dressings for healing diabetic foot ulcers. Cochrane Database Syst Rev. 2013;8:CD009099.

    Google Scholar 

  44. Dumville JC, Deshpande S, O’Meara S, Speak K. Foam dressings for healing diabetic foot ulcers. Cochrane Database Syst Rev. 2013;6:CD009111.

    Google Scholar 

  45. Dumville JC, O’Meara S, Deshpande S, Speak K. Alginate dressings for healing diabetic foot ulcers. Cochrane Database Syst Rev. 2013;6:CD009110.

    Google Scholar 

  46. Ribeiro C, Dias F, Fregonezi G. Hydrogel dressings for venous leg ulcers. Cochrane Database Syst Rev. 2013;CD010738.

    Google Scholar 

  47. Kerihuel JC. Effect of activated charcoal dressings on healing outcomes of chronic wounds. J Wound Care. 2010;19(5):208. 210–2, 214–5.

    Article  CAS  PubMed  Google Scholar 

  48. Vaneau M, Chaby G, Guillot B, Martel P, Senet P, Téot L, et al. Consensus panel recommendations for chronic and acute wound dressings. Arch Dermatol. 2007;143(10):1291–4.

    Article  PubMed  Google Scholar 

  49. Qiu Y, Qiu L, Cui J, Wei Q. Bacterial cellulose and bacterial cellulose-vaccarin membranes for wound healing. Mater Sci Eng C Mater Biol Appl. 2016;59:303–9.

    Article  CAS  PubMed  Google Scholar 

  50. Bottan S, Robotti F, Jayathissa P, Hegglin A, Bahamonde N, Heredia-Guerrero JA, et al. Surface-structured bacterial cellulose with guided assembly-based biolithography (GAB). ACS Nano. 2015;9(1):206–19.

    Article  CAS  PubMed  Google Scholar 

  51. Wu L, Norman G, Dumville JC, O’Meara S, Bell-Syer SE. Dressings for treating foot ulcers in people with diabetes: an overview of systematic reviews. Cochrane Database Syst Rev. 2015;7:CD010471.

    Google Scholar 

  52. Armstrong DG, Marston WA, Reyzelman AM, Kirsner RS. Comparative effectiveness of mechanically and electrically powered negative pressure wound therapy devices: a multicenter randomized controlled trial. Wound Repair Regen. 2012;20(3):332–41.

    Article  PubMed  Google Scholar 

  53. Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE, Weibel S. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev. 2015;6:CD004123.

    Google Scholar 

  54. Buchberger B, Follmann M, Freyer D, Huppertz H, Ehm A, Wasem J. The importance of growth factors for the treatment of chronic wounds in the case of diabetic foot ulcers. GMS Health Technol Assess. 2010;6:Doc12.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rafael Henrique Rodrigues Costa M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Costa, R.H.R., Cisneros, L.d.L., Luz, A.R. (2017). Diabetic Foot. In: Navarro, T., Dardik, A., Junqueira, D., Cisneros, L. (eds) Vascular Diseases for the Non-Specialist. Springer, Cham. https://doi.org/10.1007/978-3-319-46059-8_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-46059-8_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-46057-4

  • Online ISBN: 978-3-319-46059-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics