Diabetic foot

For infections resulting from diabetic foot disease, see Diabetic foot infection.
Diabetic foot
Other namesDiabetic foot syndrome
Neuropathic diabetic foot ulcer
SpecialtyInfectious disease, endocrinology, surgery

A diabetic foot disease is any condition that results directly from peripheral artery disease (PAD) or sensory neuropathy affecting the feet of people living with diabetes. Diabetic foot conditions can be acute or chronic complications of diabetes.[1] Presence of several characteristic diabetic foot pathologies such as infection, diabetic foot ulcer and neuropathic osteoarthropathy is called diabetic foot syndrome. The resulting bone deformity is known as Charcot foot.

Due to advanced peripheral nerve dysfunction associated with diabetes (diabetic neuropathy), patients' feet have a dryness of the skin and a reduced ability to feel pain (nociception). Hence, minor injuries may remain undiscovered and subsequently progress to a full-thickness diabetic foot ulcer. Moreover, foot surgery is well tolerated without anaesthesia.[2] The feet's insensivity to pain can easily be established by 512 mN quantitative pinprick stimulation.[3] In diabetes, peripheral nerve dysfunction can be combined with peripheral artery disease (PAD) causing poor blood circulation to the extremities (diabetic angiopathy).[4] Around half of the patients with a diabetic foot ulcer have co-existing PAD.[5] Vitamin D deficiency has been recently found to be associated with diabetic foot infections and increased risk of amputations and deaths.[6] Research estimates that the lifetime incidence of foot ulcers within the diabetic community is around 15% and may become as high as 25%.[7] Where wounds take a long time to heal, infection may set in, spreading to bones and joints, and lower limb amputation may be necessary. Foot infection is the most common cause of non-traumatic amputation in people with diabetes.[8]

  1. ^ Jalilian M, Ahmadi Sarbarzeh P, Oubari S (2020). "Factors Related to Severity of Diabetic Foot Ulcer: A Systematic Review". Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 13: 1835–1842. doi:10.2147/DMSO.S256243. PMC 7259447. PMID 32547145.
  2. ^ Arts S, Kerselaers L, De Neve J, Vanlauwe J, Cornelis S, Aerden D (2022). "Foot surgery without anesthesia in diabetic patients with sensory neuropathy: A short series". Foot & Ankle Surgery: Techniques, Reports & Cases. 2 (1). Elsevier BV: 100128. doi:10.1016/j.fastrc.2021.100128. ISSN 2667-3967. S2CID 245659745.
  3. ^ Chantelau EA (May 2021). "A Novel Diagnostic Test for End-Stage Sensory Failure Associated With Diabetic Foot Ulceration: Proof-of-Principle Study". J Diabetes Sci Technol. 15 (3): 622–629. doi:10.1177/1932296819900256. PMC 8111226. PMID 31948277.
  4. ^ Formosa C, Cassar K, Gatt A, Mizzi A, Mizzi S, Camileri KP, Azzopardi C, DeRaffaele C, Falzon O, Cristina S, Chockalingam N (November 2013). "Hidden dangers revealed by misdiagnosed peripheral arterial disease using ABPI measurement". Diabetes Res Clin Pract. 102 (2): 112–6. doi:10.1016/j.diabres.2013.10.006. PMID 24209599.
  5. ^ International Working Group on the Diabetic Foot (2015). "Guidance on the diagnosis, prognosis and management of peripheral artery disease in patients with foot ulcers in diabetes". Retrieved 23 November 2015.
  6. ^ Darlington, C., Kumar, S., Jagdish, S., Sridhar, M. Evaluation of Serum Vitamin D Levels in Diabetic Foot Infections: A Cross-Sectional Study in a Tertiary Care Center in South India. Iranian Journal of Medical Sciences, 2019; 44(6): 474-482. doi: 10.30476/ijms.2018.44951
  7. ^ Singh N, Armstrong DG, Lipsky BA (January 2005). "Preventing foot ulcers in patients with diabetes". JAMA. 293 (2): 217–28. doi:10.1001/jama.293.2.217. PMID 15644549.
  8. ^ Selva Olid A, Solà I, Barajas-Nava LA, Gianneo OD, Bonfill Cosp X, Lipsky BA (September 2015). "Systemic antibiotics for treating diabetic foot infections". Cochrane Database Syst Rev. 2015 (9): CD009061. doi:10.1002/14651858.CD009061.pub2. PMC 8504988. PMID 26337865.