Diabetic Foot

A mputation and foot ulceration are the most common consequences of diabetic neuropathy and are the major causes of morbidity and disability in patients with diabetes. Early recognition and management of independent risk factors can prevent or delay adverse outcomes. Despite the substantial morbidity resulting from foot wounds in patients with diabetes, there are no widely accepted evidence-based guidelines for assessing and treating foot ulcers and preventing their recurrence. This review article refers mostly to the recent clinical practice recommendations of the American Diabetes Association. Perform a comprehensive foot examination and provide foot self-care education annually on patients with diabetes to identify risk factors predictive of ulcers and amputations. The foot examination can be accomplished in a primary care setting and should include the use of a monofilament, tuning fork, palpation, and a visual examination. A multidisciplinary approach is recommended for individuals with foot ulcers and high-risk feet, especially those with a history of prior ulcer or amputation. Refer patients who smoke or with prior lower-extremity complications to foot care specialists for ongoing preventive care and life-long surveillance. Initial screening for peripheral arterial disease (PAD) should include a history for claudication and an assessment of the pedal pulses. Consider obtaining an ankle-brachial index (ABI), as many patients with PAD are asymptomatic. Refer patients with significant claudication or a positive ABI for further vascular assessment and consider exercise, medications, and surgical options.