The Diabetic Foot

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Introduction
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Complications in the diabetic foot is mostly caused by a triad of ischemia, Diabetic Neuropathy, and infection. [1]

Statistics about the impact of diabetic foot complications:[1]

  • Foot ulcer complications are the main reason why people with diabetes are hospitalized and have to undergo amputations.
  • 20-40% of all the health care costs comprised for diabetes are for diabetic foot complications
  • 7-10% of patients with diabetes and neuropathy will develop an ulcer; this increases up to 30% for patients with diabetes and other comorbidities.
  • 5-8% of patients will undergo a major amputation 1 year after developing a diabetic ulcer.
  • A foot ulcer preceded 85% of diabetes related amputations.
  • “Diabetes increases the risk of amputation 8-fold in patients aged >45 years,8 12-fold in patients aged>65 years and 23-fold in those aged 65––74 years.”

More information on Diabetes is available from these Physiopedia pages: DM Type 2 and DM Type 1, Diabetes

Specific Foot Conditions
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Diabetic Foot Ulcers[edit | edit source]

Diabetes Mellitus and Diabetic Ulcers

Diabetic Foot (Charcot foot/joint)[edit | edit source]

Also known as Charcot-Marie-Tooth Disease or Diabetic foot arthropathy.

More information available from  Charcot-Marie-Tooth Disease - NHS Choices (2012).

Diabetic Foot Infections[edit | edit source]

Diabetic Delayed Wound Healing[edit | edit source]

Clinically Relevant Anatomy
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Mechanism of Injury / Pathological Process
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Clinical Presentation[edit | edit source]

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Assessment[edit | edit source]

Diabetic foot/stump assessment form


 [2]

Outcome Measures[edit | edit source]

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Management / Interventions
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Physical Therapy
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  • Physical Therapists are involved in both the prevention and management of diabetic foot complications. [3] This is done by gait, posture, and foot off-loading education and training.[3]
  • Management of painful diabetic neuropathy:
    In a 2009 evidence-based literature review, the authors found that TENS might be effective for pain treatment in diabetic neuropathy.[4]


Medical Management
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  • Diabetic foot infection
    Antibiotic treatment is indicated in all infected wounds in combination with wound care, until the infection is cleared up.[1]
    Hospitilisation, immobilisation, and IV antibiotics are indicated for limb threatening or uncontrolled infections.[1]
    Urgent surgery is indicated if the infection "accompanied by a deep abscess, extensive bone or joint involvement, crepitus,
    substantial necrosis or gangrene, or necrotising fasciitis."[1]


Differential Diagnosis
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Key Evidence[edit | edit source]

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Resources
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Case Studies[edit | edit source]

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Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

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  1. 1.0 1.1 1.2 1.3 1.4 Lepäntaloa M, Apelqvistc J, Setaccie C, Riccof JB, de Donatoe G, Beckerg F, Robert-Ebadig H, Caoh P, Ecksteini HH, De Rangok P, Diehml N. Chapter V: Diabetic Foot. European Journal of Vascular and Endovascular Surgery. 2011;42(S2):S60-74. http://www.angiologiaparaclinicos.com/wp-content/uploads/2013/10/Chapter-V-Diabetic-Foot.pdf (Accessed March 2017)
  2. Youtube Video: The Diabetic Foot Exam https://youtu.be/aVz-Ja9Grvg
  3. 3.0 3.1 Kalra S, Kalra B, Kumar N. Prevention and management of diabetes: the role of the physiotherapist. Diabetes Voice. 2007;52 (3) https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjOw_PQkuvSAhXCJCYKHV_3DZkQFgghMAA&url=https%3A%2F%2Fwww.idf.org%2Fsites%2Fdefault%2Ffiles%2Fattachments%2Farticle_522_en.pdf&usg=AFQjCNF94y1s0ROyDphQwPkZIpo4F0Jeeg&sig2=eTOGhpZ_hHxZqIMTJEqCiQ (Accessed 22 March 2017)
  4. Dubinsky RM, Miyasaki J. Assessment: Efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review) Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2010 Jan 12;74(2):173-6. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjB0LrwlOvSAhUJRyYKHQHKBNYQFggcMAA&url=https%3A%2F%2Fwww.aan.com%2FPressRoom%2FHome%2FGetDigitalAsset%2F8478&usg=AFQjCNG9I0tj3VkkBttcIwjXfJmZ77rgUg&sig2=d-z_DivD6wzIHMaD-lxTlw (Accessed 22 March 2017)