Diabetic foot ulcers are complication in individuals with long-standing or poorly controlled diabetes.
They arise from unnoticed trauma, neuropathy, and foot deformities. Ulcers on feet result from lost sensation in specific areas.
Diabetic foot ulcers are staged with the Wound, Ischemia, and foot Infection system for communication between providers and risk stratification for amputation.
15% of cases with neuropathic ulcers undergo limb amputation. In this type feet are warm, well-perfused with strong pulses in high-pressure areas such as metatarsal heads and heels.
Ulcers in patients with neurologic deficits result from peripheral neuropathy that causes loss of sensation.
Treatment of diabetic foot ulcers includes offloading wound and daily moist dressings. Ignoring bone and muscle issues, infections, and circulation problems limits effectiveness of wound dressings.
Poor wound healing in lower extremities due to reduced blood flow occurs infected and slow-healing ulcers.
Epidemiology
Global prevalence of diabetic foot ulcers is around 4% to 10% among diabetic patients. 15% to 25% of individuals with diabetes will suffer from a foot ulcer in their lifetime.
Developed countries have higher prevalence rates due to advanced diagnostics options and awareness programme.
Diabetes patients with this type of ulcer are 2.5 times higher mortality risk within 5 years.
Diabetic neuropathy develops 10 years after diabetes onset to foot deformity and ulcers. Diabetic foot lesions cause most diabetes-related hospitalizations.
Anatomy
Pathophysiology
The increased occurrence of atherosclerosis and neuropathy is observed in ulcers. In diabetes, skin and tissue glycosylation is reduced collagen to cause biomechanical changes in the diabetic foot.
Arterial media thickening and calcification is common in diabetic individuals. Digital artery disease with infected ulcer nearby can cause loss of digital collaterals and gangrene.
Diabetic neuropathy causes muscle imbalances in the foot due to motor dysfunction of peripheral nerves.
Uncomfortable shoes experience, extreme temperatures, or foreign objects can lead to blisters and ulcers on feet.
Etiology
The causes of diabetic foot ulcers are:
Diabetes
Charcot foot
Pressure injuries
Peripheral neuropathy
Spinal cord injuries
Genetics
Prognostic Factors
Foot ulcers in diabetics can lead to death due to arteriosclerotic disease in major arteries.
It increased risk of limb loss with delayed treatment. Diabetes causes majority of nontraumatic amputations in US.
Management of foot ulcers in diabetics with neuropathy has a 66% recurrence rate and 12% risk of amputation.
Diabetic foot ulcers patients at high risk of premature heart death.
Neuropathic foot ulcers patients at highest risk of heart disease death.
Clinical History
Collect details including diabetes, infection, foot related care, and medical history to understand clinical history of patient.
Physical Examination
Ulcer assessment
Neurological Examination
Assessment of Peripheral Vascular Disease
Assessment of Foot Deformities
Skin and nail examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Diabetic ulcers develop slowly from pressure on foot insensate areas.
Patients with painless ulcers may not notice progression, leads to delays in treatment until complications arise.
Ulcer worsens gradually if untreated, with slow deterioration of appearance and surrounding tissue health.
Differential Diagnoses
Cutaneous T-Cell Lymphoma
Diabetic Foot Infections
Kaposi Sarcoma
Pyoderma Gangrenosum
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Treatment of diabetic foot ulcers involves dressings, moist wound care, debridement, and medication.
Topical wound management ensures moist wound bed for optimal healing. Charcot feet are treated with immobilization in special shoes, braces, and podiatric surgery.
Surgery may be considered for foot ulcers that do not resolve with conservative treatment.
Apply appropriate dressings to maintain a moist wound environment for healing.
Use topical growth factors, silver dressings, and antimicrobial agents for wound management as suggested by physician.
Debridement is used to remove nonviable tissue, debris, and bacteria from the ulcer.
Reconstructive surgery indicated if knee-high offloading devices fail to heal wounds or if patients cannot switch to diabetic shoes.
Vascular surgery recommended for re-constructible arterial lesions with intractable pain, foot ulcers, or gangrene presence.
use-of-phases-in-managing-diabetic-foot-ulcers
In the initial diagnosis phase, evaluation of medical history, physical examination, and laboratory test to confirm diagnosis.
Pharmacologic therapy is very effective in the treatment phase as it includes use of hemorrheologic agents, antiplatelet agents, and wound healing agents and surgical intervention.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and rehabilitation.
The regular follow-up visits with the physician are schedule to check the improvement of patients along with treatment response.
Diabetic foot ulcers are complication in individuals with long-standing or poorly controlled diabetes.
They arise from unnoticed trauma, neuropathy, and foot deformities. Ulcers on feet result from lost sensation in specific areas.
Diabetic foot ulcers are staged with the Wound, Ischemia, and foot Infection system for communication between providers and risk stratification for amputation.
15% of cases with neuropathic ulcers undergo limb amputation. In this type feet are warm, well-perfused with strong pulses in high-pressure areas such as metatarsal heads and heels.
Ulcers in patients with neurologic deficits result from peripheral neuropathy that causes loss of sensation.
Treatment of diabetic foot ulcers includes offloading wound and daily moist dressings. Ignoring bone and muscle issues, infections, and circulation problems limits effectiveness of wound dressings.
Poor wound healing in lower extremities due to reduced blood flow occurs infected and slow-healing ulcers.
Global prevalence of diabetic foot ulcers is around 4% to 10% among diabetic patients. 15% to 25% of individuals with diabetes will suffer from a foot ulcer in their lifetime.
Developed countries have higher prevalence rates due to advanced diagnostics options and awareness programme.
Diabetes patients with this type of ulcer are 2.5 times higher mortality risk within 5 years.
Diabetic neuropathy develops 10 years after diabetes onset to foot deformity and ulcers. Diabetic foot lesions cause most diabetes-related hospitalizations.
The increased occurrence of atherosclerosis and neuropathy is observed in ulcers. In diabetes, skin and tissue glycosylation is reduced collagen to cause biomechanical changes in the diabetic foot.
Arterial media thickening and calcification is common in diabetic individuals. Digital artery disease with infected ulcer nearby can cause loss of digital collaterals and gangrene.
Diabetic neuropathy causes muscle imbalances in the foot due to motor dysfunction of peripheral nerves.
Uncomfortable shoes experience, extreme temperatures, or foreign objects can lead to blisters and ulcers on feet.
The causes of diabetic foot ulcers are:
Diabetes
Charcot foot
Pressure injuries
Peripheral neuropathy
Spinal cord injuries
Foot ulcers in diabetics can lead to death due to arteriosclerotic disease in major arteries.
It increased risk of limb loss with delayed treatment. Diabetes causes majority of nontraumatic amputations in US.
Management of foot ulcers in diabetics with neuropathy has a 66% recurrence rate and 12% risk of amputation.
Diabetic foot ulcers patients at high risk of premature heart death.
Neuropathic foot ulcers patients at highest risk of heart disease death.
Collect details including diabetes, infection, foot related care, and medical history to understand clinical history of patient.
Ulcer assessment
Neurological Examination
Assessment of Peripheral Vascular Disease
Assessment of Foot Deformities
Skin and nail examination
Diabetic ulcers develop slowly from pressure on foot insensate areas.
Patients with painless ulcers may not notice progression, leads to delays in treatment until complications arise.
Ulcer worsens gradually if untreated, with slow deterioration of appearance and surrounding tissue health.
Cutaneous T-Cell Lymphoma
Diabetic Foot Infections
Kaposi Sarcoma
Pyoderma Gangrenosum
Treatment of diabetic foot ulcers involves dressings, moist wound care, debridement, and medication.
Topical wound management ensures moist wound bed for optimal healing. Charcot feet are treated with immobilization in special shoes, braces, and podiatric surgery.
Surgery may be considered for foot ulcers that do not resolve with conservative treatment.
Apply appropriate dressings to maintain a moist wound environment for healing.
Use topical growth factors, silver dressings, and antimicrobial agents for wound management as suggested by physician.
Endocrinology, Metabolism
Regular foot care prevents injuries and infections and avoid development of ulcers and never walk with bare foot.
Always wear comfortable shoes/sandals that fit well to reduce pressure and friction.
Diabetes patient should control their blood sugar levels to prevent nerve damage also reduce pressure on the ulcer to prevent further tissue damage.
Patient should take healthy diet and avoiding smoking to reduce the risk.
Proper education and awareness about diabetic foot ulcer should be provided and its related causes with management strategies.
Appointments with a physician and preventing recurrence of disorder is an ongoing life-long effort.
Endocrinology, Metabolism
Pentoxifylline:
It improves blood flow to reduce blood viscosity and enhance erythrocyte flexibility.
Cilostazol:
It involves inhibition of PDE and reversible inhibition of platelet aggregation.
It promotes chemotactic recruitment and proliferation of cells involved in wound repair.
Endocrinology, Metabolism
Debridement is used to remove nonviable tissue, debris, and bacteria from the ulcer.
Reconstructive surgery indicated if knee-high offloading devices fail to heal wounds or if patients cannot switch to diabetic shoes.
Vascular surgery recommended for re-constructible arterial lesions with intractable pain, foot ulcers, or gangrene presence.
Endocrinology, Metabolism
In the initial diagnosis phase, evaluation of medical history, physical examination, and laboratory test to confirm diagnosis.
Pharmacologic therapy is very effective in the treatment phase as it includes use of hemorrheologic agents, antiplatelet agents, and wound healing agents and surgical intervention.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and rehabilitation.
The regular follow-up visits with the physician are schedule to check the improvement of patients along with treatment response.
Diabetic foot ulcers are complication in individuals with long-standing or poorly controlled diabetes.
They arise from unnoticed trauma, neuropathy, and foot deformities. Ulcers on feet result from lost sensation in specific areas.
Diabetic foot ulcers are staged with the Wound, Ischemia, and foot Infection system for communication between providers and risk stratification for amputation.
15% of cases with neuropathic ulcers undergo limb amputation. In this type feet are warm, well-perfused with strong pulses in high-pressure areas such as metatarsal heads and heels.
Ulcers in patients with neurologic deficits result from peripheral neuropathy that causes loss of sensation.
Treatment of diabetic foot ulcers includes offloading wound and daily moist dressings. Ignoring bone and muscle issues, infections, and circulation problems limits effectiveness of wound dressings.
Poor wound healing in lower extremities due to reduced blood flow occurs infected and slow-healing ulcers.
Global prevalence of diabetic foot ulcers is around 4% to 10% among diabetic patients. 15% to 25% of individuals with diabetes will suffer from a foot ulcer in their lifetime.
Developed countries have higher prevalence rates due to advanced diagnostics options and awareness programme.
Diabetes patients with this type of ulcer are 2.5 times higher mortality risk within 5 years.
Diabetic neuropathy develops 10 years after diabetes onset to foot deformity and ulcers. Diabetic foot lesions cause most diabetes-related hospitalizations.
The increased occurrence of atherosclerosis and neuropathy is observed in ulcers. In diabetes, skin and tissue glycosylation is reduced collagen to cause biomechanical changes in the diabetic foot.
Arterial media thickening and calcification is common in diabetic individuals. Digital artery disease with infected ulcer nearby can cause loss of digital collaterals and gangrene.
Diabetic neuropathy causes muscle imbalances in the foot due to motor dysfunction of peripheral nerves.
Uncomfortable shoes experience, extreme temperatures, or foreign objects can lead to blisters and ulcers on feet.
The causes of diabetic foot ulcers are:
Diabetes
Charcot foot
Pressure injuries
Peripheral neuropathy
Spinal cord injuries
Foot ulcers in diabetics can lead to death due to arteriosclerotic disease in major arteries.
It increased risk of limb loss with delayed treatment. Diabetes causes majority of nontraumatic amputations in US.
Management of foot ulcers in diabetics with neuropathy has a 66% recurrence rate and 12% risk of amputation.
Diabetic foot ulcers patients at high risk of premature heart death.
Neuropathic foot ulcers patients at highest risk of heart disease death.
Collect details including diabetes, infection, foot related care, and medical history to understand clinical history of patient.
Ulcer assessment
Neurological Examination
Assessment of Peripheral Vascular Disease
Assessment of Foot Deformities
Skin and nail examination
Diabetic ulcers develop slowly from pressure on foot insensate areas.
Patients with painless ulcers may not notice progression, leads to delays in treatment until complications arise.
Ulcer worsens gradually if untreated, with slow deterioration of appearance and surrounding tissue health.
Cutaneous T-Cell Lymphoma
Diabetic Foot Infections
Kaposi Sarcoma
Pyoderma Gangrenosum
Treatment of diabetic foot ulcers involves dressings, moist wound care, debridement, and medication.
Topical wound management ensures moist wound bed for optimal healing. Charcot feet are treated with immobilization in special shoes, braces, and podiatric surgery.
Surgery may be considered for foot ulcers that do not resolve with conservative treatment.
Apply appropriate dressings to maintain a moist wound environment for healing.
Use topical growth factors, silver dressings, and antimicrobial agents for wound management as suggested by physician.
Endocrinology, Metabolism
Regular foot care prevents injuries and infections and avoid development of ulcers and never walk with bare foot.
Always wear comfortable shoes/sandals that fit well to reduce pressure and friction.
Diabetes patient should control their blood sugar levels to prevent nerve damage also reduce pressure on the ulcer to prevent further tissue damage.
Patient should take healthy diet and avoiding smoking to reduce the risk.
Proper education and awareness about diabetic foot ulcer should be provided and its related causes with management strategies.
Appointments with a physician and preventing recurrence of disorder is an ongoing life-long effort.
Endocrinology, Metabolism
Pentoxifylline:
It improves blood flow to reduce blood viscosity and enhance erythrocyte flexibility.
Cilostazol:
It involves inhibition of PDE and reversible inhibition of platelet aggregation.
It promotes chemotactic recruitment and proliferation of cells involved in wound repair.
Endocrinology, Metabolism
Debridement is used to remove nonviable tissue, debris, and bacteria from the ulcer.
Reconstructive surgery indicated if knee-high offloading devices fail to heal wounds or if patients cannot switch to diabetic shoes.
Vascular surgery recommended for re-constructible arterial lesions with intractable pain, foot ulcers, or gangrene presence.
Endocrinology, Metabolism
In the initial diagnosis phase, evaluation of medical history, physical examination, and laboratory test to confirm diagnosis.
Pharmacologic therapy is very effective in the treatment phase as it includes use of hemorrheologic agents, antiplatelet agents, and wound healing agents and surgical intervention.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and rehabilitation.
The regular follow-up visits with the physician are schedule to check the improvement of patients along with treatment response.
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