Diabetic foot ulcer management: the podiatrist's perspective
Diabetic foot complications result from two broad pathologies—neuropathic and neuro-ischaemic feet. It is important for diabetic patients to have at least a yearly review of foot ulcer risk factors, and they should have a corresponding risk classification agreed based on this assessment. Diabetic foot ulcer assessment should include a wound classification tool, which can give an indication of wounds at greater risk of non-healing or amputation. The treatment of diabetic foot ulcers should be part of a comprehensive care plan that should also include treatment of infection, frequent debridement (if deemed appropriate by a skilled specialist clinician), biomechanical offloading, blood glucose control and treatment of comorbidities. Clinicians should base dressing selection on the wound’s location, size and depth, amount of exudate, presence of infection or necrosis and the condition of the surrounding tissue.
Clinical studies suggest that foot ulcers precede 84% of non-traumatic lower extremity amputations in individuals with diabetes.1 Ulceration and amputation substantially reduce quality of life and are associated with high mortality. 50% of patients with diabetes who have had an amputation survive a further 2 years. Even without amputation, the prognosis is poor. Only around 56% of patients with diabetes who have had foot ulcers survive for 5 years.2
In 2010/11, 8.8% of all hospital admissions (with at least one overnight stay) for patients with diabetes involved a foot problem. There were 5917 non-traumatic lower extremity amputation admissions, and more than 66,000 other admissions involving foot complications. Furthermore, the average length of hospital stay for people with diabetic foot problems is 13 days longer than for people with diabetes who do not have foot problems.2
Diabetic foot complications result from the following two broad pathologies (Table 1).
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