J Korean Med Assoc.  2013 Mar;56(3):220-228. 10.5124/jkma.2013.56.3.220.

Prevention and management of the diabetic foot

• Lee HS

• KMID: 2064827
• DOI: http://doi.org/10.5124/jkma.2013.56.3.220

Abstract

In the diabetic foot, ulceration and amputation are the most serious causes of morbidity and disability in these patients. Peripheral arterial sclerosis, peripheral neuropathy, and foot deformities are major causes of foot problems. Foot deformities caused by autonomic and motor neuropathy lead, in turn, to over-pressured focal lesions causing the diabetic foot to be easily injured within the shoe while walking. Wound healing can be difficult in these patients because of impaired phagocytic activity by hyperglycemia, impaired migration of leukocytes due to a thickened basement membrane, malnutrition, and ischemia. Deformity correction or shoe modification to relieve the pressure of over-pressured points is necessary for ulcer management. Selective dressings allowing a moist environment following complete debridement of the necrotic tissue is mandatory. In the case of a large soft tissue defect due to aggressive debridement, a wound coverage procedure is necessary by either a distant flap operation or a skin graft. Amputation can be necessary in the case of an intractable ischemic toe or a life-threatening infected limb. The amputation level should be kept at its minimum to allow patients to walk, with or without a prosthesis, post-amputation. A foot with Charcot's joint should be stabilized and consolidated into a plantigrade foot. The bony prominence of a Charcot foot can be corrected by a bumpectomy for prevention of ulceration. The most effective management of the diabetic foot is ulcer prevention; measures include controlling blood sugar levels, controlling neuropathic pain, smoking cessation, stretching exercises, frequent inspection of the foot, and education on appropriate footwear. A multidisciplinary approach is also highly recommended for managing diabetic foot problems.

Keyword

Diabetic foot; Therapeutics; Prevention & control

MeSH Terms

Amputation
Arthropathy, Neurogenic
Bandages
Basement Membrane
Blood Glucose
Congenital Abnormalities
Debridement
Diabetic Foot
Exercise
Extremities
Foot
Foot Deformities
Humans
Hyperglycemia
Ischemia
Leukocytes
Malnutrition
Neuralgia
Peripheral Nervous System Diseases
Prostheses and Implants
Sclerosis
Shoes
Skin
Smoking Cessation
Toes
Transplants
Ulcer
Walking
Wound Healing
Blood Glucose

Figure

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  Figure 1 (A) Intractable plantar ulcer on the lateral side of right foot with (B) varus deformity.

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  Figure 2 (A) Intractable plantar ulcer over (B) the bony prominence (arrow) in Charcot foot.

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  Figure 3 (A) Left mid foot Charcot was mis-diagnosed as osteomyelitis. (B) Charcot foot and osteomyelitis can not be differentiated on the magnetic resonance imaging.

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  Figure 4 (A) Chronic wound on the lateral side of right foot with (B) osteomyelitis of 5th metatarsal head (arrow).

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