Assessment and management of foot disease in patients with diabetes.

Limb- or life-threatening complications in patients with diabetes can be prevented with an integrated, multidisciplinary approach. Most patients seen in clinical practice are in the early stages of the disease process. Glycemic control retards the progression of neuropathy, which is the most important risk factor for ulceration. Early detection of the loss of protective sensation and implementation of strategies to prevent ulceration will reduce the rates of limb-threatening complications. Clinicians should routinely examine the feet of diabetic patients. Education in foot care, proper footwear, and close follow-up are required to prevent or promptly detect neuropathic injury. If ulceration occurs, removal of pressure from the site of the ulcer and careful management of the wound will allow healing in most cases. The failure to heal despite these measures should prompt a search for associated arterial insufficiency. If infection is present, appropriate antimicrobial therapy combined with immediate surgical intervention, including revascularization when necessary, will increase the chances of saving the limb. With this comprehensive approach, it is possible to achieve the goal of a 40 percent decrease in amputation rates among diabetic patients by the year 2000.

[1]  J. Malone,et al.  Guillotine amputation in the treatment of nonsalvageable lower-extremity infections. , 1984, Archives of surgery.

[2]  G. Reiber,et al.  Diabetic Foot Care: Financial Implications and Practice Guidelines , 1992, Diabetes Care.

[3]  R. Adkins,et al.  Randomized Controlled Trial of Topical Hyperbaric Oxygen for Treatment of Diabetic Foot Ulcers , 1988, Diabetes Care.

[4]  F. Logerfo,et al.  Improved quality of diabetic foot care, 1984 vs 1990. Reduced length of stay and costs, insufficient reimbursement. , 1993, Archives of surgery.

[5]  G. Reiber,et al.  Pathways to Diabetic Limb Amputation: Basis for Prevention , 1990, Diabetes Care.

[6]  F. Logerfo,et al.  Current concepts. Vascular and microvascular disease of the foot in diabetes. Implications for foot care. , 1984, The New England journal of medicine.

[7]  M. Myerson,et al.  The total-contact cast for management of neuropathic plantar ulceration of the foot. , 1992, The Journal of bone and joint surgery. American volume.

[8]  D. Sims,et al.  Plantar sensory threshold in the ulcerative foot. , 1986, Leprosy review.

[9]  Anthony Delitto,et al.  Total Contact Casting in Treatment of Diabetic Plantar Ulcers: Controlled Clinical Trial , 1989, Diabetes Care.

[10]  J. Giurini,et al.  Review of metatarsal osteotomies for the treatment of neuropathic ulcerations. , 1990, Journal of the American Podiatric Medical Association.

[11]  M. Dhanendran,et al.  Vertical forces acting on the feet of diabetic patients with neuropathic ulceration , 1981, The British journal of surgery.

[12]  M. McGrath,et al.  Peptide growth factors and wound healing. , 1990, Clinics in plastic surgery.

[13]  J. Adams,et al.  Radiographic Abnormalities in the Feet of Patients With Diabetic Neuropathy , 1994, Diabetes Care.

[14]  D. Bild,et al.  Comparison of Quantitative Sensory-Threshold Measures for Their Association With Foot Ulceration in Diabetic Patients , 1990, Diabetes Care.

[15]  A. Veves,et al.  Use of Experimental Padded Hosiery to Reduce Abnormal Foot Pressures in Diabetic Neuropathy , 1989, Diabetes Care.

[16]  Peter R. Cavanagh,et al.  In-shoe plantar pressure measurement: a review , 1992 .

[17]  C. I. Franks,et al.  Dynamic Foot Pressure and Other Studies as Diagnostic and Management Aids in Diabetic Neuropathy , 1983, Diabetes Care.

[18]  M. McGuckin,et al.  Occlusive dressings: a microbiologic and clinical review. , 1990, American journal of infection control.

[19]  W. Jeffcoate,et al.  A Microbiological Study of Diabetic Foot Lesions , 1985, Diabetic medicine : a journal of the British Diabetic Association.

[20]  W. Lineaweaver,et al.  Topical antimicrobial toxicity. , 1985, Archives of surgery.

[21]  A. Novick,et al.  Effect of a Walking Splint and Total Contact Casts on Plantar Forces , 1991 .

[22]  M. Robson,et al.  Comparison of Silver Sulfadiazine, Povidone‐Iodine and Physiologic Saline in the Treatment of Chronic Pressure Ulcers , 1981, Journal of the American Geriatrics Society.

[23]  G. A. Holloway,et al.  Randomized Prospective Double-Blind Trial in Healing Chronic Diabetic Foot Ulcers: CT-102 activated platelet supernatant, topical versus placebo , 1992, Diabetes Care.

[24]  P. Cavanagh,et al.  The Effect of Callus Removal on Dynamic Plantar Foot Pressures in Diabetic Patients , 1992, Diabetic medicine : a journal of the British Diabetic Association.

[25]  S. Soulier.  The use of running shoes in the prevention of plantar diabetic ulcers. , 1986, Journal of the American Podiatric Medical Association.

[26]  P. Brand,et al.  The total contact cast. A therapy for plantar ulceration on insensitive feet. , 1984, Journal of the American Podiatry Association.

[27]  D. Gerding,et al.  Osteomyelitis in the feet of diabetic patients. Long-term results, prognostic factors, and the role of antimicrobial and surgical therapy. , 1987, The American journal of medicine.

[28]  A. Boulton.  The Diabetic Foot: Neuropathic in Aetiology? , 1990 .

[29]  Benjamin A Lipsky,et al.  The diabetic foot. Soft tissue and bone infection. , 1990, Infectious disease clinics of North America.

[30]  F. Logerfo,et al.  A flexible approach to infrapopliteal vein grafts in patients with diabetes mellitus. , 1991, Archives of surgery.

[31]  J. Montgomerie,et al.  The infected foot of the diabetic patient: quantitative microbiology and analysis of clinical features. , 1984, Reviews of infectious diseases.

[32]  A. Burden,et al.  Use of the "Scotchcast boot" in treating diabetic foot ulcers. , 1983, British medical journal.

[33]  L. Peterson,et al.  Therapy of lower extremity infections with ciprofloxacin in patients with diabetes mellitus, peripheral vascular disease, or both. , 1989, The American journal of medicine.

[34]  W. Quist,et al.  Trends in the care of the diabetic foot. Expanded role of arterial reconstruction. , 1992, Archives of surgery.

[35]  L. Parish,et al.  RATIONAL APPROACH TO WOUND CARE , 1992, International journal of dermatology.

[36]  J. Bowker,et al.  Impaired Vibratory Perception and Diabetic Foot Ulceration , 1986, Diabetic medicine : a journal of the British Diabetic Association.