Inpatient management of diabetic foot disorders: A clinical guide

Dane K. Wukich, David G. Armstrong, Christopher E. Attinger, Andrew J M Boulton, Patrick R. Burns, Robert G. Frykberg, Richard Hellman, Paul J. Kim, Benjamin A. Lipsky, James C. Pile, Michael S. Pinzur, Linda Siminerio

Research output: Contribution to journalReview article

54 Citations (Scopus)

Abstract

The implementation of an inpatient diabetic foot service should be the goal of all institutions that care for patients with diabetes. The objectives of this team are to prevent problems in patients while hospitalized, provide curative measures for patients admitted with diabetic foot disorders, and optimize the transition frominpatient to outpatient care. Essential skills that are required for an inpatient team include the ability to stage a foot wound, assess for peripheral vascular disease, neuropathy, wound infection, and the need for debridement; appropriately culture a wound and select antibiotic therapy; provide, directly or indirectly, for optimal metabolic control; and implement effective discharge planning to prevent a recurrence. Diabetic foot ulcers may be present in patients who are admitted for nonfoot problems, and these ulcers should be evaluated by the diabetic foot team during the hospitalization. Pathways should be in place for urgent or emergent treatment of diabetic foot infections and neuropathic fractures/dislocations. Surgeons involved with these patients should have knowledge and interest in limb preservation techniques. Prevention of iatrogenic foot complications, such as pressure sores of the heel, should be a priority in patients with diabetes who are admitted for any reason: all hospitalized diabetic patients require a clinical foot exam on admission to identify risk factors such as loss of sensation or ischemia. Appropriate posthospitalization monitoring to reduce the risk of reulceration and infection should be available, which should include optimal glycemic control and correction of any fluid and electrolyte disturbances.

Original languageEnglish (US)
Pages (from-to)2862-2871
Number of pages10
JournalDiabetes Care
Volume36
Issue number9
DOIs
StatePublished - Sep 1 2013

Fingerprint

Diabetic Foot
Inpatients
Foot
Aptitude
Peripheral Vascular Diseases
Heel
Patient Discharge
Pressure Ulcer
Wounds and Injuries
Debridement
Wound Infection
Ambulatory Care
Infection
Electrolytes
Ulcer
Patient Care
Hospitalization
Ischemia
Extremities
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Wukich, D. K., Armstrong, D. G., Attinger, C. E., Boulton, A. J. M., Burns, P. R., Frykberg, R. G., ... Siminerio, L. (2013). Inpatient management of diabetic foot disorders: A clinical guide. Diabetes Care, 36(9), 2862-2871. https://doi.org/10.2337/dc12-2712

Inpatient management of diabetic foot disorders : A clinical guide. / Wukich, Dane K.; Armstrong, David G.; Attinger, Christopher E.; Boulton, Andrew J M; Burns, Patrick R.; Frykberg, Robert G.; Hellman, Richard; Kim, Paul J.; Lipsky, Benjamin A.; Pile, James C.; Pinzur, Michael S.; Siminerio, Linda.

In: Diabetes Care, Vol. 36, No. 9, 01.09.2013, p. 2862-2871.

Research output: Contribution to journalReview article

Wukich, DK, Armstrong, DG, Attinger, CE, Boulton, AJM, Burns, PR, Frykberg, RG, Hellman, R, Kim, PJ, Lipsky, BA, Pile, JC, Pinzur, MS & Siminerio, L 2013, 'Inpatient management of diabetic foot disorders: A clinical guide', Diabetes Care, vol. 36, no. 9, pp. 2862-2871. https://doi.org/10.2337/dc12-2712
Wukich DK, Armstrong DG, Attinger CE, Boulton AJM, Burns PR, Frykberg RG et al. Inpatient management of diabetic foot disorders: A clinical guide. Diabetes Care. 2013 Sep 1;36(9):2862-2871. https://doi.org/10.2337/dc12-2712
Wukich, Dane K. ; Armstrong, David G. ; Attinger, Christopher E. ; Boulton, Andrew J M ; Burns, Patrick R. ; Frykberg, Robert G. ; Hellman, Richard ; Kim, Paul J. ; Lipsky, Benjamin A. ; Pile, James C. ; Pinzur, Michael S. ; Siminerio, Linda. / Inpatient management of diabetic foot disorders : A clinical guide. In: Diabetes Care. 2013 ; Vol. 36, No. 9. pp. 2862-2871.
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