Diagnosis & Management of Diabetic Foot Complications
Originally published in a 2018 American Diabetes Association compendium, this review by Andrew J.M. Boulton, David G. Armstrong, and Robert S. Kirsner offers a comprehensive roadmap for addressing diabetic foot complications, with a focus on prevention, timely diagnosis, and limb preservation.
Key Insights:
- Prevalence & Burden: Diabetic foot ulcers (DFUs) affect up to 34% of people with diabetes in their lifetime. DFUs are the leading cause of lower-extremity amputations, many of which are preventable with early intervention.
- Risk Factors: Peripheral neuropathy, peripheral artery disease, foot deformity, infection, and poor glycemic control significantly increase DFU and amputation risk.
- Screening & Diagnosis: The authors emphasize regular foot exams, monofilament testing, vascular assessment, and the use of classification tools like the Wagner or University of Texas systems.
- Management Strategies: Effective treatment includes offloading, sharp debridement, infection control, vascular evaluation, and referral to a multidisciplinary team when necessary.
- Advanced Therapies: Adjunctive approaches include growth factors, skin substitutes, stem cell-based products, hyperbaric oxygen therapy, and negative pressure wound therapy—especially for non-healing or complex wounds.
- Charcot Neuroarthropathy: Often underdiagnosed, Charcot foot requires early recognition and prolonged offloading to prevent collapse and ulceration.
This ADA compendium remains a foundational resource for clinicians working to reduce DFU incidence and preserve limbs through coordinated, evidence-based care.
Keywords:
Andrew J.M. Boulton,
David G. Armstrong,
Robert S. Kirsner,
diabetic foot ulcer,
Charcot foot,
offloading,
hyperbaric oxygen therapy,
negative pressure wound therapy,
limb preservation