Diabetic foot overview: Difference between revisions
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==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
The incidence of active diabetic foot ulcers is approximately 630 per 100,000 diabetic individuals world wide. According to an other estimate the incidence of diabetic foot ulcers is approximately 1500 per 100,000 individuals worldwide. The 5 year risk of mortality in diabetic patients with a foot ulcer is 2.5 times higher than diabetic individuals without a foot ulcer. Diabetic foot ulcer has a higher incidence in men.<ref name="pmid28614678">{{cite journal| author=Armstrong DG, Boulton AJM, Bus SA| title=Diabetic Foot Ulcers and Their Recurrence. | journal=N Engl J Med | year= 2017 | volume= 376 | issue= 24 | pages= 2367-2375 | pmid=28614678 | doi=10.1056/NEJMra1615439 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28614678 }} </ref><ref name="pmid12027925">{{cite journal| author=Abbott CA, Carrington AL, Ashe H, Bath S, Every LC, Griffiths J et al.| title=The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. | journal=Diabet Med | year= 2002 | volume= 19 | issue= 5 | pages= 377-84 | pmid=12027925 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12027925 }} </ref><ref name="pmid27585063">{{cite journal| author=Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y| title=Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis (†). | journal=Ann Med | year= 2017 | volume= 49 | issue= 2 | pages= 106-116 | pmid=27585063 | doi=10.1080/07853890.2016.1231932 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27585063 }} </ref><ref name="pmid16731996">{{cite journal| author=Boyko EJ, Ahroni JH, Cohen V, Nelson KM, Heagerty PJ| title=Prediction of diabetic foot ulcer occurrence using commonly available clinical information: the Seattle Diabetic Foot Study. | journal=Diabetes Care | year= 2006 | volume= 29 | issue= 6 | pages= 1202-7 | pmid=16731996 | doi=10.2337/dc05-2031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16731996 }} </ref> | |||
==Risk Factors== | ==Risk Factors== | ||
Revision as of 13:30, 16 June 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]
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Overview
Type 2 diabetes and its complications are now considered as a growing health threat. It is the leading cause of blindness, end stage renal disease, coronary heart disease and foot ulceration which leads to amputations. In general, the incidence of nontraumatic lower extremity amputations has been reported to be at least 15 times greater in those with diabetes than with any other medical illness. Among patients with diabetes, the lifetime risk of having foot ulcer is 15%. Diabetic foot ulcers dramatically worsen the physical, psychological and social quality of life [1]. 1 in every 4 patients with diabetes develops complications. The pathogenesis of diabetics foot is due to two causes i.e. neuropathy and vasculopathy. Due to neuropathy the patient loses sensation whereas, vasculopathy causes poor blood supply to the foot region. Due to both these contributing factors, even a small trauma to the feet can give rise to ulcer or gangrene and may even require amputation. Thus, foot examination by a podiatrist or a doctor is recommended every year.
Historical Perspective
The association between diabetes and foot ulceration and infection dates back to the 1850s. Significant breakthroughs in the management of diabetic foot wounds include the introduction of surgical debridement in the early 1900s, the discovery of penicillin in 1928, and advances in surgical revascularization and angioplasty. These remain mainstays of diabetic foot management, per 2004 and 2012 IDSA guidelines.
Classification
Pathophysiology
Causes
Differentiating Diabetes foot other Diseases
Epidemiology and Demographics
The incidence of active diabetic foot ulcers is approximately 630 per 100,000 diabetic individuals world wide. According to an other estimate the incidence of diabetic foot ulcers is approximately 1500 per 100,000 individuals worldwide. The 5 year risk of mortality in diabetic patients with a foot ulcer is 2.5 times higher than diabetic individuals without a foot ulcer. Diabetic foot ulcer has a higher incidence in men.[2][3][4][5]
Risk Factors
Screening
Natural History, Complications and Prognosis
Patients with diabetic foot have an increased risk of all-cause mortality, especially cardiovascular disorders, compared with patients with diabetes without a history of diabetic foot ulcer. The complications of diabetic foot ulcers include infection, sepsis, osteomyelitis and death.[6][2]
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Appropriate wound care is essential for the management of all diabetic foot ulcers. Uninfected diabetic ulcers do not require antibiotic therapy. For acutely infected wounds, empiric antibiotic with efficacy against Gram-positive cocci should be initiated after obtaining a post-debridement specimen for aerobic and anaerobic culture. Infections with antibiotic-resistant organisms and those that are chronic, previously treated, or severe usually require broader spectrum regimens.
Surgery
Primary Prevention
The primary prevention of diabetic foot ulcer includes control of blood sugar levels , pressure offloading, frequent physical examinations, good foot hygiene, diabetic socks and shoes, and by avoiding injury.
Secondary Prevention
The secondary prevention of diabetic foot ulcer includes pressure offloading, prevention of infection, treatment of infection, debridement and reconstruction of the damaged blood vessels, along with the use of primary preventive strategies.[2]
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
References
- ↑ Assal JP, Mehnert H, Tritschler HJ, Sidorenko A, Keen H, Hellmut Mehnert Award Workshop Participants (2002). "On your feet! Workshop on the diabetic foot". J Diabetes Complications. 16 (2): 183–94. PMID 12039404.
- ↑ 2.0 2.1 2.2 Armstrong DG, Boulton AJM, Bus SA (2017). "Diabetic Foot Ulcers and Their Recurrence". N Engl J Med. 376 (24): 2367–2375. doi:10.1056/NEJMra1615439. PMID 28614678.
- ↑ Abbott CA, Carrington AL, Ashe H, Bath S, Every LC, Griffiths J; et al. (2002). "The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort". Diabet Med. 19 (5): 377–84. PMID 12027925.
- ↑ Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y (2017). "Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis (†)". Ann Med. 49 (2): 106–116. doi:10.1080/07853890.2016.1231932. PMID 27585063.
- ↑ Boyko EJ, Ahroni JH, Cohen V, Nelson KM, Heagerty PJ (2006). "Prediction of diabetic foot ulcer occurrence using commonly available clinical information: the Seattle Diabetic Foot Study". Diabetes Care. 29 (6): 1202–7. doi:10.2337/dc05-2031. PMID 16731996.
- ↑ Brownrigg JR, Davey J, Holt PJ, Davis WA, Thompson MM, Ray KK; et al. (2012). "The association of ulceration of the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis". Diabetologia. 55 (11): 2906–12. doi:10.1007/s00125-012-2673-3. PMID 22890823.