Diabetic foot

Prevention of diabetic foot may include optimising metabolic control via the regulation of blood glucose levels; identification and screening of people at high risk for diabetic foot ulceration, especially those with advanced painless neuropathy; and patient education in order to promote foot self-examination and foot care knowledge. Patients would be taught routinely to inspect their feet for hyperkeratosis, fungal infection, skin lesions and foot deformities. Control of footwear is also important as repeated trauma from tight shoes can be a triggering factor,{{cite journal | vauthors = Stiegler H | title = [Diabetic foot syndrome] | language = German | journal = Herz | volume = 29 | issue = 1 | pages = 104–15 | date = February 2004 | pmid = 14968346 | doi = 10.1007/s00059-004-2534-z |s2cid=39360504}} especially where peripheral neuropathy is present. Evidence is limited that low-quality patient education courses have a long-term preventative impact.

Foot screening guidelines have been previously reviewed, with a view to examining their completeness in terms of advancement in clinical practice, improvements in technology, and changes in socio-cultural structure. Results suggested that limitations of available guidelines and lack of evidence on which the guidelines were based were responsible for the gaps between guidelines, standard clinical practice, and development of complications. It concluded that for the development of standard recommendations and everyday clinical practice, it was necessary to pay more attention to both the limitations of guidelines and the underlying evidence.{{cite journal | vauthors = Formosa C, Gatt A, Chockalingam N | title = A Critical Evaluation of Existing Diabetic Foot Screening Guidelines | journal = Rev Diabet Stud | volume = 13 | issue = 2–3 | pages = 158–186 | date = 2016 | pmid = 28012281 | pmc = 5553765 | doi = 10.1900/RDS.2016.13.158 }}

According to a 2011 meta-analysis of randomised controlled trials, only foot temperature-guided avoidance therapy was found beneficial in preventing ulceration.{{cite journal | vauthors = Arad Y, Fonseca V, Peters A, Vinik A | title = Beyond the monofilament for the insensate diabetic foot: a systematic review of randomized trials to prevent the occurrence of plantar foot ulcers in patients with diabetes | journal = Diabetes Care | volume = 34 | issue = 4 | pages = 1041–6 | date = April 2011 | pmid = 21447666 | pmc = 3064020 | doi = 10.2337/dc10-1666 }}

Monitoring a person's feet can help in predicting the likelihood of developing ulcers. A common method for this is using a special thermometer to look for spots on the foot that have higher temperature which indicate the possibility of an ulcer developing.{{Cite journal |date=2022-06-21 |title=Simple tool identifies the people with diabetes most likely to develop foot ulcers |url=https://evidence.nihr.ac.uk/alert/simple-tool-predicts-foot-ulcers-in-diabetes/ |journal=NIHR Evidence |language=en |publisher=National Institute for Health and Care Research |doi=10.3310/nihrevidence_51316|s2cid=251787297 |url-access=subscription }} At the same time there is no strong scientific evidence supporting the effectiveness of at-home foot temperature monitoring.{{cite journal | vauthors = Golledge J, Fernando ME, Alahakoon C, Lazzarini PA, Aan de Stegge WB, van Netten JJ, Bus SA | title = Efficacy of at home monitoring of foot temperature for risk reduction of diabetes-related foot ulcer: A meta-analysis | journal = Diabetes Metab Res Rev | volume = 38 | issue = 6 | pages = e3549 | date = September 2022 | pmid = 35605998 | pmc = 9541448 | doi = 10.1002/dmrr.3549 |s2cid=251981184}}

The current guideline in the United Kingdom recommends collecting 8-10 pieces of information for predicting the development of foot ulcers.{{Cite web |title=Diabetic foot problems: prevention and management |url=https://www.nice.org.uk/guidance/ng19/chapter/Recommendations#assessing-the-risk-of-developing-a-diabetic-foot-problem |access-date=2022-09-06 |website=National Institute for Health and Care Excellence (NICE)|date=26 August 2015 }} A simpler method proposed by researchers provides a more detailed risk score based on three pieces of information (insensitivity, foot pulse, previous history of ulcers or amputation). This method is not meant to replace people regularly checking their own feet but complement it.{{cite journal | vauthors = Chappell FM, Crawford F, Horne M, Leese GP, Martin A, Weller D, Boulton AJ, Abbott C, Monteiro-Soares M, Veves A, Riley RD|display-authors = 6 | title = Development and validation of a clinical prediction rule for development of diabetic foot ulceration: an analysis of data from five cohort studies | journal = BMJ Open Diabetes Res Care | volume = 9 | issue = 1 | pages = e002150| date = May 2021 | pmid = 34035053 | pmc = 8154962 | doi = 10.1136/bmjdrc-2021-002150 }}

Once ulcers develop, the Wagner and UT scales are two methods that physicians use to determine the severity of the ulcer. These scales are the best known predictors of lower extremity amputations once ulcers develop.{{cite journal |vauthors=Jeon BJ, Choi HJ, Kang JS, Tak MS, Park ES |title=Comparison of five systems of classification of diabetic foot ulcers and predictive factors for amputation |journal=Int Wound J |volume=14 |issue=3 |pages=537–545 |date=June 2017 |pmid=27723246 |doi=10.1111/iwj.12642 |pmc=7949506 }}

Treatment of diabetic foot ulceration can be challenging and prolonged; it may include orthopaedic appliances, surgery and antimicrobial drugs and topical dressings.{{cite journal|vauthors=((Dorresteijn JAN)), ((Kriegsman DMW)), ((Assendelft WJJ)), Valk GD|title=Patient education for preventing diabetic foot ulceration|journal=Cochrane Database of Systematic Reviews|date=2014|volume=2014 |issue=12|pages=CD001488|doi=10.1002/14651858.CD001488.pub5|pmid=25514250|pmc=7057029|hdl=2066/108980|hdl-access=free}}

Most diabetic foot infections (DFIs) require treatment with systemic antibiotics. The choice of the initial antibiotic treatment depends on several factors such as the severity of the infection, whether the patient has received another antibiotic treatment for it, and whether the infection has been caused by a micro-organism that is known to be resistant to usual antibiotics (e.g. MRSA). The objective of antibiotic therapy is to stop the infection and ensure it does not spread.{{cite journal|vauthors=Bader MS|title=Diabetic Foot Infection|issue=1 |pages=71–79 |journal=American Family Physician|date=July 2008 |volume=78 |pmid=18649613 |url=https://www.aafp.org/afp/2008/0701/p71.html|access-date=8 October 2020}}

It is unclear whether any particular antibiotic is better than any other for curing infection or avoiding amputation. One trial suggested that ertapenem with or without vancomycin is more effective than tigecycline for resolving DFIs. It is also generally unclear whether different antibiotics are associated with more or fewer adverse effects.

It is recommended however that the antibiotics used for treatment of diabetic foot ulcers should be used after deep tissue culture of the wound. Tissue culture and not pus swab culture should be done. Antibiotics should be used at correct doses in order to prevent the emergence of drug resistance. It is unclear if local antibiotics improve outcomes after surgery.{{cite journal | vauthors = Marson BA, Deshmukh SR, Grindlay DJ, Ollivere BJ, Scammell BE | title = A systematic review of local antibiotic devices used to improve wound healing following the surgical management of foot infections in diabetics | journal = Bone Joint J | volume = 100-B | issue = 11 | pages = 1409–15 | date = November 2018 | pmid = 30418057 | doi = 10.1302/0301-620X.100B11.BJJ-2018-0720 | s2cid = 53280854 }}

• Diabetic dermopathy
• Diabetic foot infection

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• [https://www.nlm.nih.gov/medlineplus/diabeticfoot.html MedlinePlus: Diabetic Foot]

{{Diabetes}}

Category:Complications of diabetes

Category:Foot diseases