Australian Diabetes Foot Network: management of diabetes‐related foot ulceration — a clinical update

Appropriate assessment and management of diabetes‐related foot ulcers (DRFUs) is essential to reduce amputation risk. Management requires debridement, wound dressing, pressure off‐loading, good glycaemic control and potentially antibiotic therapy and vascular intervention. As a minimum, all DRFUs should be managed by a doctor and a podiatrist and/or wound care nurse. Health professionals unable to provide appropriate care for people with DRFUs should promptly refer individuals to professionals with the requisite knowledge and skills. Indicators for immediate referral to an emergency department or multidisciplinary foot care team (MFCT) include gangrene, limb‐threatening ischaemia, deep ulcers (bone, joint or tendon in the wound base), ascending cellulitis, systemic symptoms of infection and abscesses. Referral to an MFCT should occur if there is lack of wound progress after 4 weeks of appropriate treatment.

[1]  F. W. Wagner,et al.  The Dysvascular Foot: A System for Diagnosis and Treatment , 1981, Foot & ankle.

[2]  L T Cotton,et al.  Improved survival of the diabetic foot: the role of a specialized foot clinic. , 1986, The Quarterly journal of medicine.

[3]  C. Agardh,et al.  Decreasing Incidence of Major Amputation in Diabetic Patients: a Consequence of a Multidisciplinary Foot Care Team Approach? , 1995, Diabetic medicine : a journal of the British Diabetic Association.

[4]  C. Sachon,et al.  Treatment of Osteomyelitis in the Diabetic Foot: Contribution of conservative surgery , 1996, Diabetes Care.

[5]  D. Steed,et al.  Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. Diabetic Ulcer Study Group. , 1996, Journal of the American College of Surgeons.

[6]  David G Armstrong,et al.  Validation of a Diabetic Wound Classification System: The contribution of depth, infection, and ischemia to risk of amputation , 1998, Diabetes Care.

[7]  J. Peters,et al.  The Epidemiology and Cost of Inpatient Care for Peripheral Vascular Disease, Infection, Neuropathy, and Ulceration in Diabetes , 1998, Diabetes Care.

[8]  D G Smith,et al.  Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. , 1999, Diabetes care.

[9]  Benjamin A Lipsky,et al.  Diagnosis and Treatment of Diabetic Foot Infections , 1988, Bailliere's best practice & research. Clinical rheumatology.

[10]  J. Smith,et al.  Debridement of diabetic foot ulcers. , 2002, The Cochrane database of systematic reviews.

[11]  J. Calhoun,et al.  Diabetic Foot Ulcers and Infections: Current Concepts , 2002, Advances in skin & wound care.

[12]  Benjamin A Lipsky A report from the international consensus on diagnosing and treating the infected diabetic foot , 2004, Diabetes/metabolism research and reviews.

[13]  Stephanie Wu,et al.  Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: a randomized controlled trial. , 2005, Diabetes care.

[14]  D. Armstrong,et al.  Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial , 2005, The Lancet.

[15]  P. Norman,et al.  Predictors, consequences and costs of diabetes-related lower extremity amputation complicating type 2 diabetes: The Fremantle Diabetes Study , 2006, Diabetologia.

[16]  D. Armstrong,et al.  Probe-to-Bone Test for Diagnosing Diabetic Foot Osteomyelitis , 2007, Diabetes Care.

[17]  R. V. Deursen,et al.  The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review , 2008, Diabetes/metabolism research and reviews.

[18]  W. Houtum,et al.  Practical guidelines on the management and prevention of the diabetic foot , 2008, Diabetes/metabolism research and reviews.

[19]  R J Hinchliffe,et al.  Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment , 2008, Diabetes/metabolism research and reviews.

[20]  P. Cavanagh,et al.  Off-loading the diabetic foot for ulcer prevention and healing. , 2010, Journal of vascular surgery.

[21]  V. Basevi Standards of Medical Care in Diabetes—2010 , 2010, Diabetes Care.

[22]  D. Armstrong,et al.  A stepwise approach for surgical management of diabetic foot infections. , 2010, Journal of the American Podiatric Medical Association.

[23]  J. Mills,et al.  Current assessment of endovascular therapy for infrainguinal arterial occlusive disease in patients with diabetes. , 2010, Journal of the American Podiatric Medical Association.

[24]  D. Armstrong,et al.  The role of interdisciplinary team approach in the management of the diabetic foot: a joint statement from the Society for Vascular Surgery and the American Podiatric Medical Association. , 2010, Journal of the American Podiatric Medical Association.

[25]  R. Frykberg,et al.  Surgical off-loading of the diabetic foot. , 2010, Journal of vascular surgery.