Managing complications of the diabetic foot

• Published in: BMJ 2009-12, Vol.339 (7733), p.1304-1307
• Main Authors: Cheer, Kelly, Shearman, Cliff, Jude, Edward B
• Format: Article
• Language: English
• Subjects: Ambulatory Care; Amputation; Ankle; Anti-Bacterial Agents - therapeutic use; Charcot-Marie-Tooth Disease - diagnosis; Charcot-Marie-Tooth Disease - etiology; Charcot-Marie-Tooth Disease - therapy; CLINICAL REVIEW; Diabetes; Diabetes complications; Diabetic angiopathies; Diabetic foot; Diabetic Foot - etiology; Diabetic Foot - therapy; Diabetic neuropathies; Foot deformities; Foot diseases; Foot ulcer; Foot Ulcer - etiology; Foot Ulcer - therapy; Gangrene; Hospitals; Humans; Infections; Mortality; Osteomyelitis - diagnosis; Osteomyelitis - etiology; Pain; Patient Care Team; Patient education; Peripheral Nervous System Diseases - etiology; Peripheral Nervous System Diseases - therapy; Peripheral Vascular Diseases - etiology; Peripheral Vascular Diseases - therapy; Physical Examination - methods; Practice Guidelines as Topic; Risk Factors; Task forces; Type 2 diabetes mellitus; Ulcers; Working groups
• ISSN: 0959-8138; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.b4905

5 Tips for non-specialists Patients with a new foot ulcer, a foot ulcer with osteomyelitis or gangrene, or those with or without a foot ulcer who have cellulitis should be referred to a specialist foot clinic Patients with pain on resting or intermittent claudication, plus those with an ankle brachial pressure index â[per thousand]¤0.5, should also be referred Patients with severe infection-systemic toxicity or fever, tachycardia, vomiting, confusion, severe hyperglycaemia, or renal failure-should be admitted to hospital Patients with peripheral arterial disease and non-healing wounds should be urgently assessed by vascular surgeons Patients with infection and foot ulcers who are unlikely to comply with outpatient medical treatment and who lack home support will need to be admitted A hot swollen foot is indicative of Charcot's foot, which needs early diagnosis and treatment to avoid permanent deformity Additional educational resources Resources for patients Patients UK ( www.patient.co.uk/health/Diabetes-Foot-Care-A-Summary.htm )-This leaflet summarises how people with diabetes can prevent foot ulcers Family Doctor ( http://familydoctor.org/online/famdocen/home/common/diabetes/living/352.html )-Useful tips for patients with diabetes on how to look after their feet Uptodate ( www.uptodate.com/patients/content/topic.do?topicKey=~hL//tcPc67nF2 )-Patient information about foot care in diabetes Resources for healthcare professionals: