Author(s) Boulton, Andrew JM, et al.

Journal . Date of publication 2016 Jan 1;volume ():.

Abstract Diabetic foot ulcers (DFU) are associated with significant impairment of quality of life, increased morbidity and mortality and are a huge drain on health care resources. In western countries, the annual incidence of foot ulceration in the diabetic population is around 2%. DFUs develop as a consequence of a combination of factors, most commonly peripheral neuropathy (loss of the gift of pain), peripheral vascular disease and some form of unperceived trauma. Recent studies emphasize the very high prevalence of foot ulceration in diabetic patients on dialysis as a consequence of end-stage renal disease. The mortality in this patient group is higher than for most forms of cancer. All patients with diabetes should have an annual screen to identify their foot ulcer risk status: those with any risk factors require specific foot care education as well as regular contact with a health care professional, usually a podiatrist. DFUs should heal if there is an adequate arterial inflow, infection is aggressively managed and pressure is removed from the wound and its margins. In the management of plantar neuropathic ulcers, offloading is critical and all efforts must be made to enhance patient understanding of the need for offloading. Antibiotic usage should be guided by clinical signs of infection and microbiologic analysis of deep tissue specimens. Most adjunctive therapies have little evidence to support their use though negative pressure wound therapy has been shown to be helpful in certain cases. There is currently no indication for hyperbaric oxygen usage. Charcot neuroarthropathy (CN) should be easily preventable: most important is to treat any neuropathic patient with a warm swollen foot as having CN until proven otherwise. For complete coverage of all related aeas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG. Copyright © 2000-2017, MDText.com, Inc.

Source ID (e.g. PMID): 28121117