Diagnosis and management of diabetic foot complications

Andrew J.M. Boulton, David G. Armstrong, Robert S. Kirsner, Christopher E. Attinger, Lawrence A Lavery, Benjamin A. Lipsky, Joseph L. Mills, John S. Steinberg

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

At least half of all amputations occur in people with diabetes, most commonly because of an infected diabetic foot ulcer. A thorough understanding of the causes and management of diabetic foot ulceration is essential to reducing lower-extremity amputation risk. This compendium elucidates the pathways leading to foot ulcers and enumerates multiple contributory risk factors. The authors emphasize the importance of appropriate screening and wound classification and explain when patients should be referred for specialist care, targeted education, or therapeutic shoes or insoles. They provide a comprehensive review of treatment approaches, including devices for foot lesion off-loading and aggressive wound debridement through mechanical, enzymatic, autolytic, biologic, and surgical means. Because infection and peripheral artery disease are key contributors to amputation risk, the authors discuss the diagnosis and management of these conditions in detail. They also review the expanding armamentarium of evidence-based adjunctive treatments for foot ulcers, including growth factors, skin substitutes, stem cells, and other biologics. Because Charcot neuroarthropathy is a serious but frequently missed condition in people with diabetic neuropathy, the authors explain the differential diagnosis of the hot, swollen foot that is a hallmark of this condition. The article ends with an overview of four strategies for maintaining a foot in remission, followed by a brief look at the future of diabetic foot care.

Original languageEnglish (US)
Pages (from-to)1-20
Number of pages20
JournalDiabetes
Volume2018
Issue number2
DOIs
StatePublished - Jan 1 2018

Fingerprint

Diabetic Foot
Diabetes Complications
Amputation
Foot Ulcer
Foot
Artificial Skin
Shoes
Diabetic Neuropathies
Peripheral Arterial Disease
Wounds and Injuries
Debridement
Biological Products
Lower Extremity
Intercellular Signaling Peptides and Proteins
Differential Diagnosis
Stem Cells
Therapeutics
Education
Equipment and Supplies
Infection

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Boulton, A. J. M., Armstrong, D. G., Kirsner, R. S., Attinger, C. E., Lavery, L. A., Lipsky, B. A., ... Steinberg, J. S. (2018). Diagnosis and management of diabetic foot complications. Diabetes, 2018(2), 1-20. https://doi.org/10.2337/DB20182-1

Diagnosis and management of diabetic foot complications. / Boulton, Andrew J.M.; Armstrong, David G.; Kirsner, Robert S.; Attinger, Christopher E.; Lavery, Lawrence A; Lipsky, Benjamin A.; Mills, Joseph L.; Steinberg, John S.

In: Diabetes, Vol. 2018, No. 2, 01.01.2018, p. 1-20.

Research output: Contribution to journalArticle

Boulton, AJM, Armstrong, DG, Kirsner, RS, Attinger, CE, Lavery, LA, Lipsky, BA, Mills, JL & Steinberg, JS 2018, 'Diagnosis and management of diabetic foot complications', Diabetes, vol. 2018, no. 2, pp. 1-20. https://doi.org/10.2337/DB20182-1
Boulton AJM, Armstrong DG, Kirsner RS, Attinger CE, Lavery LA, Lipsky BA et al. Diagnosis and management of diabetic foot complications. Diabetes. 2018 Jan 1;2018(2):1-20. https://doi.org/10.2337/DB20182-1
Boulton, Andrew J.M. ; Armstrong, David G. ; Kirsner, Robert S. ; Attinger, Christopher E. ; Lavery, Lawrence A ; Lipsky, Benjamin A. ; Mills, Joseph L. ; Steinberg, John S. / Diagnosis and management of diabetic foot complications. In: Diabetes. 2018 ; Vol. 2018, No. 2. pp. 1-20.
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