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| __NOTOC__ | | __NOTOC__ |
| | {| class="infobox" style="float:right;" |
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| | | [[File:Siren.gif|30px|link=Diabetic foot resident survival guide]]|| <br> || <br> |
| | | [[Diabetic foot resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
| | |} |
| '''For patient information, click [[Diabetic foot (patient information)|here]]''' | | '''For patient information, click [[Diabetic foot (patient information)|here]]''' |
| {{Infobox_Disease | | | {{Infobox_Disease | |
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| {{Diabetic foot}} | | {{Diabetic foot}} |
| {{Diabetes mellitus }} | | {{Diabetes mellitus }} |
| {{CMG}}; [[Afsaneh Morteza|Afsaneh Morteza, MD-MPH]] [mailto:afsaneh.morteza@gmail.com] '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; {{CZ}} | | {{CMG}}; [[Afsaneh Morteza|Afsaneh Morteza, MD-MPH]] [mailto:afsaneh.morteza@gmail.com] {{AE}} {{Anahita}} {{DG}}; [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; {{CZ}} |
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| | {{SK}} Diabetic feet; Diabetic ulcer; Diabetic foot infection; Diabetic foot ulcer; Diabetic foot syndrome |
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| ==Treatment== | | ==[[Diabetic foot overview|Overview]]== |
| Foot ulcers in diabetes require multidisciplinary assessment, usually by diabetes specialists and [[surgeon]]s. Treatment consists of appropriate bandages, [[antibiotic]]s (against [[staphylococcus]], [[streptococcus]] and [[anaerobe]] strains), [[debridement]] and arterial revascularisation. It is often 500 mg to 1000 mg of [[flucloxacillin]], 1 g of [[amoxicillin]] and also [[metronidazole]] to tackle the putrid smelling bacteria. Specialists are investigating the role of [[nitric oxide]] in diabetic wound healing. Nitric oxide is a powerful vasodilator, which helps to bring nutrients to the oxygen deficient wound beds. Specialists are using forms of [[light therapy]] such as LLLT to treat diabetic ulcers.
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| | ==[[Diabetic foot historical perspective|Historical Perspective]]== |
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| | ==[[Diabetic foot classification|Classification]]== |
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| ==Prevention== | | ==[[Diabetic foot pathophysiology|Pathophysiology]]== |
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| Foot ulcers can be prevented by is by frequent physical examinations, good foot hygiene, [[diabetic sock]]s and shoes, and by avoiding injury.
| | ==[[Diabetic foot causes|Causes]]== |
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| * Foot-care education combined with increased surveillance can reduce the incidence of serious foot lesions <ref name="pmid8498761">{{cite journal |author=Litzelman D, Slemenda C, Langefeld C, Hays L, Welch M, Bild D, Ford E, Vinicor F |title=Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus. A randomized, controlled trial |journal=Ann Intern Med |volume=119 |issue=1 |pages=36-41 |year=1993 |pmid=8498761}}</ref>.
| | ==[[Differentiating Diabetic foot from other diseases|Differentiating Diabetic foot from other Diseases]]== |
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| * Footwear; all major reviews recommend special footwear for patients with a prior ulcer or with foot deformities. One review added neuropathy as an indication for special footwear. The comparison of custom shoes versus well-chosen and well-fitted athletic shoes is not clear.
| | ==[[Diabetic foot epidemiology and demographics|Epidemiology and Demographics]]== |
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| ====Clinical Trials==== | | ==[[Diabetic foot risk factors|Risk Factors]]== |
| ''Clinical Evidence'' reviewed the topic and concluded "Individuals with significant foot deformities should be considered for referral and assessment for customized shoes that can accommodate the altered foot anatomy. In the absence of significant deformities, high quality well fitting non-prescription footwear seems to be a reasonable option" <ref name="pmid16620415">{{cite journal |author=Hunt D |title=Foot ulcers and amputations in diabetes |journal=Clin Evid |volume= |issue= |pages=455-62 |year= |pmid=16620415 |url = http://clinicalevidence.com/ceweb/conditions/dia/0602/0602_I5.jsp | based on September 2005 search}}</ref>.
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| [[National Institute for Health and Clinical Excellence]] has reviewed the topic and concluded that for patients at "high risk of foot ulcers (neuropathy or absent pulses plus deformity or skin changes or previous ulcer" that "specialist footwear and insoles" should be provided <ref name="webNICE">{{cite web | | ==[[Diabetic foot screening|Screening]]== |
| | title = Scope: Management of type 2 diabetes: prevention and management of foot problems (update)
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| | work = Clinical Guidelines and Evidence Review for Type 2 Diabetes: Prevention and Management of Foot Problems
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| | publisher = National Institute for Health and Clinical Excellence
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| | date = 20 February 2003
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| | url = http://www.nice.org.uk/nicemedia/pdf/footcare_scope.pdf
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| | format = PDF
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| | accessdate = 2007-12-04
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| }}</ref>
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| A [[meta-analysis]] by the [[Cochrane Collaboration]] concluded that "there is very limited evidence of the effectiveness of therapeutic shoes" <ref name="pmid10908550">{{cite journal |author=Spencer S |title=Pressure relieving interventions for preventing and treating diabetic foot ulcers |journal=Cochrane Database Syst Rev |volume= |issue= |pages=CD002302 |year= |pmid=10908550 | doi=10.1002/14651858.CD002302}}</ref>. However, the meta-analysis was published before the major trial that is in the table below.
| | ==[[Diabetic foot natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| The major [[randomized controlled trial]] of specialized footwear show no benefit in patients with a prior foot ulceration (see table below).<ref name="pmid12020336">{{cite journal| author=Reiber GE, Smith DG, Wallace C, Sullivan K, Hayes S, Vath C et al.| title=Effect of therapeutic footwear on foot reulceration in patients with diabetes: a randomized controlled trial. | journal=JAMA | year= 2002 | volume= 287 | issue= 19 | pages= 2552-8 | pmid=12020336 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12020336 }} </ref> A prior, smaller, non-randomized trial that showed benefit of custom foot wear in patients with a prior foot ulceration.<ref name=pmid8721941">{{cite journal |author=Uccioli L, Faglia E, Monticone G, Favales F, Durola L, Aldeghi A, Quarantiello A, Calia P, Menzinger G |title=Manufactured shoes in the prevention of diabetic foot ulcers |journal=Diabetes Care |volume=18 |issue=10 |pages=1376-8 |year=1995 |pmid=8721941}}</ref>. In this trial, the [[number needed to treat]] was 4 patients.
| | ==Diagnosis== |
| | [[Diabetic foot history and symptoms|History and Symptoms]] | [[Diabetic foot physical examination|Physical Examination]] | [[Diabetic foot laboratory findings|Laboratory Findings]] | [[Diabetic foot electrocardiogram|Electrocardiogram]] | [[Diabetic foot x ray|X Ray]] | [[Diabetic foot CT|CT]] | [[Diabetic foot MRI|MRI]] | [[Diabetic foot echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Diabetic foot other imaging findings|Other Imaging Findings]] | [[Diabetic foot other diagnostic studies|Other Diagnostic Studies]] |
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| {| class="wikitable"
| | ==Treatment== |
| |+ [[Randomized controlled trial]]s of interventions to prevent complications of diabetic foot.<ref name="pmid12020336">{{cite journal| author=Reiber GE, Smith DG, Wallace C, Sullivan K, Hayes S, Vath C et al.| title=Effect of therapeutic footwear on foot reulceration in patients with diabetes: a randomized controlled trial. | journal=JAMA | year= 2002 | volume= 287 | issue= 19 | pages= 2552-8 | pmid=12020336 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12020336 }} </ref> <ref name="pmid8498761">{{cite journal| author=Litzelman DK, Slemenda CW, Langefeld CD, Hays LM, Welch MA, Bild DE et al.| title=Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus. A randomized, controlled trial. | journal=Ann Intern Med | year= 1993 | volume= 119 | issue= 1 | pages= 36-41 | pmid=8498761 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8498761 }} </ref> <ref name="pmid9472868">{{cite journal| author=McCabe CJ, Stevenson RC, Dolan AM| title=Evaluation of a diabetic foot screening and protection programme. | journal=Diabet Med | year= 1998 | volume= 15 | issue= 1 | pages= 80-4 | pmid=9472868 | doi=10.1002/(SICI)1096-9136(199801)15:1<80::AID-DIA517>3.0.CO;2-K | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9472868 }} </ref> <ref name="pmid18758747">{{cite journal| author=Lincoln NB, Radford KA, Game FL, Jeffcoate WJ| title=Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial. | journal=Diabetologia | year= 2008 | volume= 51 | issue= 11 | pages= 1954-61 | pmid=18758747 | doi=10.1007/s00125-008-1110-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18758747 }} </ref>
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| ! rowspan="2"|Trial!!rowspan="2"| Patients!!rowspan="2"| Intervention!!rowspan="2"|Comparison !!rowspan="2"|Outcome!!colspan="2"|Results!!rowspan="2"|Comment
| | [[Diabetic foot comprehensive therapy|Comprehensive therapy]] | [[Diabetic foot medical therapy|Medical Therapy]] | [[Diabetic foot surgery|Surgery]] | [[Diabetic foot primary prevention|Primary Prevention]] | [[Diabetic foot secondary prevention|Secondary Prevention]] | [[Diabetic foot cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Diabetic foot future or investigational therapies|Future or Investigational Therapies]] |
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| ! Intervention!!Control
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| | Litzelman<ref name="pmid8498761"/><br/>1993|| 395 patients<br/>• general medicine practice|| Patient and provider education||Usual care||• Any foot lesion<br/> • Serious foot lesions at one year|| Not reported||• 11%<br/>• 2.9%||<br/>• Insignificant <br/>• Significant reduction
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| | Lincoln<ref name="pmid18758747"/><br/>2008|| 172 patients<br/>• Prior ulceration<br/>• specialist clinic|| Targeted, one-to-one education ||Usual care||Re-ulceration at<br/>• 1 year<br/>2 years|| • 30%<br/>• 41%||• 20%<br/>• 41%||• Insignificant<br/>• Insignificant
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| | McCabe<ref name="pmid9472868"/><br/>1998|| 2002 patients<br/>• high-risk<br/>• general diabetic clinic|| Screening and referral to foot-care clinic if they had prior ulcer, had low ankle–brachial index (<0.75), or had foot deformities||Usual care||• Ulceration within 2 years<br/>• Amputation rates|| • 2%<br/>• 0.1%|| 4%<br/>1.2%||• Insignificant<br/>• Significant
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| | Reiber<ref name="pmid12020336"/><br/>2002|| 400 patients<br/>• Prior ulceration<br/>• Excluded severe deformity||Therapeutic shoes||Usual footwear|| Re-ulceration || 15%|| 17%|| Insignificant difference
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| |}
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| ==External Links== | | ==Case Studies== |
| * [http://diabetic-foot.net Diabetic Foot Research Page] at the Center for Lower Extremity Ambulatory Research; for Professionals and Patients
| | [[Diabetic foot case study one|Case #1]] |
| * [http://gentili.net/diabeticfoot/ Imaging of the Diabetic Foot and Its Complications]
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| * [http://www.podiatrytoday.com/article/5164 Assessing The Potential of Nitric Oxide in the Diabetic Foot]
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| * [http://www.ucihs.uci.edu/com/pathology/sherman/home_pg.htm Maggot Therapy Project]
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| ==References==
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| {{reflist|2}}
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |
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| [[Category:Disease]]
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| [[Category:Medicine]]
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| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
| [[Category:Endocrinology]] | | [[Category:Endocrinology]] |
| [[Category:Mature chapter]]
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| [[Category:Diabetes]]
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| [[Category:Aging-associated diseases]]
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| [[Category:Medical conditions related to obesity]]
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| [[Category:Primary care]]
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| [[Category:Intensive care medicine]]
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