Table of contents
Diabetic foot
What's new
Updated 2024 ADA guidelines for the diagnosis and management of diabetic foot.
Background
Overview
Definition
Diabetic foot is a complication of diabetes characterized by a triad of neuropathy, ischemia, and infection.
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Pathophysiology
Diabetic foot is caused due to uncontrolled diabetes leading to the development of peripheral neuropathy (loss of sensation) and PAD (ischemia).
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Disease course
Clinical manifestations due to peripheral neuropathy lead to fissures, bullae, Charcot joint, edema, digital necrosis; and ischemia lead to pain at rest, ulceration on foot margins, digital necrosis, and gangrene. Disease progression may lead to osteomyelitis (chronic discharging sinus and sausage-like appearance of the toe) and gangrene formation that may require amputation.
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Prognosis and risk of recurrence
The all-cause mortality related to diabetic foot ulcer and lower extremity amputation is 42.54 per 1,000 person-years and 86.80 per 1,000 person-years.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of diabetic foot are prepared by our editorial team based on guidelines from the American Diabetes Association (ADA 2024) and the Society for Vascular Medicine (SVM/SVS/APMA 2016).
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Screening and diagnosis
Indications for screening, average-risk patients: as per ADA 2024 guidelines, obtain comprehensive foot evaluations at least annually to identify risk factors for ulcers and amputations.
A
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Indications for screening (high-risk patients)
Indications for screening (pediatric patients)
Diagnostic investigations
Medical history: as per ADA 2024 guidelines, elicit a history of ulceration, amputation, Charcot foot, angioplasty or vascular surgery, cigarette smoking, retinopathy, and renal disease and assess current symptoms of neuropathy (pain, burning, numbness) and vascular disease (leg fatigue, claudication).
B
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Physical examination
Ankle-brachial index
Medical management
Interprofessional care: as per ADA 2024 guidelines, ensure an interprofessional approach facilitated by a podiatrist in conjunction with other appropriate team members in patients with foot ulcers and high-risk feet (such as patients on dialysis, with Charcot foot, history of ulcers or amputation, or PAD).
B
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Glycemic control
Nonpharmacologic interventions
Therapeutic procedures
Revascularization
As per APMA/SVM/SVS 2016 guidelines:
Do not perform prophylactic arterial revascularization to prevent diabetic foot ulcer.
D
Perform revascularization by either surgical bypass or endovascular therapy in patients with diabetic foot ulcer and PAD.
B
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Other therapies
Surgical interventions
Wound care
As per APMA/SVM/SVS 2016 guidelines:
Obtain frequent evaluation at 1-4-week intervals with measurement of diabetic foot ulcers to monitor reduction of wound size and healing progress.
B
Use dressing products maintaining a moist wound bed, controlling exudate, and avoiding maceration of surrounding intact skin in patients with diabetic foot ulcers.
B
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Surgical debridement
Patient education
Foot self-care education: as per ADA 2024 guidelines, provide general preventive foot self-care education to all patients with diabetes, including patients with loss of protective sensation, on appropriate ways to examine their feet (palpation or visual inspection with an unbreakable mirror) for daily surveillance of early foot problems.
B