Contemporary Evaluation and Management of the Diabetic Foot

Abstract

Foot problems in patients with diabetes remain a major public health issue and are the commonest reason for hospitalization of patients with diabetes with prevalence as high as 25%. Ulcers are breaks in the dermal barrier with subsequent erosion of underlying subcutaneous tissue that may extend to muscle and bone, and superimposed infection is a frequent and costly complication. The pathophysiology of diabetic foot disease is multifactorial and includes neuropathy, infection, ischemia, and abnormal foot structure and biomechanics. Early recognition of the etiology of these foot lesions is essential for good functional outcome. Managing the diabetic foot is a complex clinical problem requiring a multidisciplinary collaboration of health care workers to achieve limb salvage. Adequate off-loading, frequent debridement, moist wound care, treatment of infection, and revascularization of ischemic limbs are the mainstays of therapy. Even when properly managed, some of the foot ulcers do not heal and are arrested in a state of chronic inflammation. These wounds can frequently benefit from various adjuvants, such as aggressive debridement, growth factors, bioactive skin equivalents, and negative pressure wound therapy. While these, increasingly expensive, therapies have shown promising results in clinical trials, the results have yet to be translated into widespread clinical practice leaving a huge scope for further research in this field.

European diabetes research and its funding, 2002–2013

“…Research on latent autoimmune diabetes of adults and maturity-onset diabetes of the young was under-represented in terms of research papers, although it appeared to attract considerable funding support. A gap in funding opportunities was shown for topics such as the effect of diabetes on the feet, which is of critical importance to patients and to clinical care, and for which few management strategies exist [19]. European funders and policy-makers should consider triangulating these findings on outputs and funding with trends in the burden of disease when planning future diabetes research portfolios.…”

Diabetic foot ulcer care: a concept analysis of the term integrated into nursing practice

“…However, clinical nurses are encouraged to work in partnership with clinical laboratory analyst for measuring those biomarkers. In addition, several evaluations should be conducted during the treatment such as follow‐up care ; collaborating with radiologists in order to evaluate ulcers using imaging techniques ; evaluating the ulcer grade ; and evaluating hyperglycaemia, PAD, neuropathy and nutritional status .…”

“…Evaluation is a determination process of the individual's responses to the particular treatments in regard to which the outcomes have been accomplished. Several aspects have been acknowledged as outcome measurements such as: HbA1c , high‐density lipoprotein , procalcitonin , potential hydrogen (pH) of wound fluid , wound size and follow‐up care ; collaborating with radiologists in order to evaluate ulcers using imaging techniques ; evaluating the ulcer grade ; and evaluating hyperglycaemia, peripheral artery disease, neuropathy and nutritional status .…”

“…All of these descriptions are harmonious with nursing practice, particularly in DFU care. On the other hand, numerous DFU literatures mentioned the term of 'management' (5, [26][27][28][29][30][31], which may possibly give rise to confusion regarding the understanding of the term, 'care'. Consequently, we also then explored and revealed that 'management' is a universal concept that has been used in many disciplines, not only in the health sciences.…”

Development of Assessment and Screening Tool to Assist with Prevention and Identification of Charcot Foot in Type 2 Diabetics

“…For patients who are unaware of an injury, which progresses to an ulceration, "the average cost of treatment ranges from $3609 to $27, 721" [39]. Regardless of whether a patient is in need of complex therapy over an extended period of time or is simply required to be in some form of offloading device during the acute phase of Charcot foot, the potential for financial strain is inevitable.…”