Foot Problems in Diabetes: An Overview

Diabetes is the leading cause of nontraumatic lower-extremity amputations in the United States. Most amputations are preceded by an ulcer, and ulcers are costly in their own right. Most ulcers are neuropathic in etiology and plantar in location. They occur typically at sites of high mechanical loadi...

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Bibliographic Details
Published in:Clinical infectious diseases 2004-08, Vol.39 (Supplement-2), p.S73-S82
Main Authors: Ulbrecht, Jan S., Cavanagh, Peter R., Caputo, Gregory M.
Format: Article
Language:English
Subjects:
Amputation
Biological and medical sciences
Diabetes
Diabetes complications
Diabetes. Impaired glucose tolerance
Diabetic foot
Diabetic Foot - microbiology
Diabetic Foot - physiopathology
Diabetic Foot - therapy
Diabetic neuropathies
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Foot ulcer
Footwear
Healing
Humans
Infections
Medical sciences
Soft Tissue Infections
Somatosensory Disorders
Ulcers
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Summary:Diabetes is the leading cause of nontraumatic lower-extremity amputations in the United States. Most amputations are preceded by an ulcer, and ulcers are costly in their own right. Most ulcers are neuropathic in etiology and plantar in location. They occur typically at sites of high mechanical loading because of repetitive trauma in people with loss of pain sensation. In an adequately perfused limb, such ulcers are not difficult to heal. When they are properly mechanically off-loaded, ∼90% of these wounds heal in ∼6 weeks. The reference standard off-loading device is the total contact cast, but other reasonably efficacious methods exist. Screening and implementation of preventive measures in the high-risk patient are highly recommended and can reduce the incidence of ulceration. All patients with diabetes should be screened annually for loss of protective sensation, with the 10-g Semmes-Weinstein monofilament being the easiest tool to use. Education to prevent complications should be implemented for all patients with loss of protective sensation.
ISSN:1058-4838
1537-6591
DOI:10.1086/383266