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Preventing and treating foot complications associated with diabetes mellitus

Nature Reviews Endocrinology volume 11, pages 606–616 (2015)Cite this article

Subjects

Key Points

  • A comprehensive foot examination is essential for the appropriate assessment, prevention and management of diabetic foot complications

  • Peripheral neuropathy is concurrent with 90% of foot ulcers and is a major contributor to the development of ulcers in patients with diabetes mellitus

  • Many patients with diabetes mellitus who have peripheral vascular disease are asymptomatic until they develop tissue loss

  • In the context of tissue loss, increasing ischaemia elevates the risk of limb loss and, therefore, healing usually requires revascularization

  • Revascularization can be performed using endovascular or open surgery techniques, or a combination of both, and depends on the patient's health, the location of the disease and local surgical expertise

  • Offloading, debridement, antibiotics, optimal glycaemic control and a multidisciplinary team are fundamental to the effective treatment of diabetic foot complications

Abstract

Diabetes mellitus is associated with a series of macrovascular and microvascular changes that can manifest as a wide range of complications. Foot ulcerations affect ∼2–4% of patients with diabetes mellitus. Risk factors for foot lesions include peripheral and autonomic neuropathy, vascular disease and previous foot ulceration, as well as other microvascular complications, such as retinopathy and end-stage renal disease. Ulceration is the result of a combination of components that together lead to tissue breakdown. The most frequently occurring causal pathways to the development of foot ulcers include peripheral neuropathy and vascular disease, foot deformity or trauma. Peripheral vascular disease is often not diagnosed in patients with diabetes mellitus until tissue loss is evident, usually in the form of a nonhealing ulcer. Identification of patients with diabetes mellitus who are at high risk of ulceration is important and can be achieved via annual foot screening with subsequent multidisciplinary foot-care interventions. Understanding the factors that place patients with diabetes mellitus at high risk of ulceration, together with an appreciation of the links between different aspects of the disease process, is essential to the prevention and management of diabetic foot complications.

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Figure 1: 5-year patency estimates for surgical bypass in critical limb ischaemia.

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  1. Manchester Royal Infirmary, University of Manchester, 193 Hathersage Road, Manchester, M13 0JE, UK

    Frank L. Bowling, S. Tawqeer Rashid & Andrew J. M. Boulton

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Bowling, F., Rashid, S. & Boulton, A. Preventing and treating foot complications associated with diabetes mellitus. Nat Rev Endocrinol 11, 606–616 (2015). https://doi.org/10.1038/nrendo.2015.130

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