Diabetic foot

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Diabetic foot
Diabetic Foot Infection: Cellulitis and gangrene.
(Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)

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Diabetes mellitus Main page

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Afsaneh Morteza, MD-MPH [2] Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [3]; Cafer Zorkun, M.D., Ph.D. [4]

Prevention

Foot ulcers can be prevented by is by frequent physical examinations, good foot hygiene, diabetic socks and shoes, and by avoiding injury.

  • Foot-care education combined with increased surveillance can reduce the incidence of serious foot lesions [1].
  • Footwear; all major reviews recommend special footwear for patients with a prior ulcer or with foot deformities. One review added neuropathy as an indication for special footwear. The comparison of custom shoes versus well-chosen and well-fitted athletic shoes is not clear.

Clinical Trials

Clinical Evidence reviewed the topic and concluded "Individuals with significant foot deformities should be considered for referral and assessment for customized shoes that can accommodate the altered foot anatomy. In the absence of significant deformities, high quality well fitting non-prescription footwear seems to be a reasonable option" [2].

National Institute for Health and Clinical Excellence has reviewed the topic and concluded that for patients at "high risk of foot ulcers (neuropathy or absent pulses plus deformity or skin changes or previous ulcer" that "specialist footwear and insoles" should be provided [3]

A meta-analysis by the Cochrane Collaboration concluded that "there is very limited evidence of the effectiveness of therapeutic shoes" [4]. However, the meta-analysis was published before the major trial that is in the table below.

The major randomized controlled trial of specialized footwear show no benefit in patients with a prior foot ulceration (see table below).[5] A prior, smaller, non-randomized trial that showed benefit of custom foot wear in patients with a prior foot ulceration.[6]. In this trial, the number needed to treat was 4 patients.

Randomized controlled trials of interventions to prevent complications of diabetic foot.[5] [1] [7] [8]
Trial Patients Intervention Comparison Outcome Results Comment
Intervention Control
Litzelman[1]
1993
395 patients
• general medicine practice
Patient and provider education Usual care • Any foot lesion
• Serious foot lesions at one year
Not reported • 11%
• 2.9%

• Insignificant
• Significant reduction
Lincoln[8]
2008
172 patients
• Prior ulceration
• specialist clinic
Targeted, one-to-one education Usual care Re-ulceration at
• 1 year
2 years
• 30%
• 41%
• 20%
• 41%
• Insignificant
• Insignificant
McCabe[7]
1998
2002 patients
• high-risk
• general diabetic clinic
Screening and referral to foot-care clinic if they had prior ulcer, had low ankle–brachial index (<0.75), or had foot deformities Usual care • Ulceration within 2 years
• Amputation rates
• 2%
• 0.1%
4%
1.2%
• Insignificant
• Significant
Reiber[5]
2002
400 patients
• Prior ulceration
• Excluded severe deformity
Therapeutic shoes Usual footwear Re-ulceration 15% 17% Insignificant difference

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References

  1. 1.0 1.1 1.2 Litzelman D, Slemenda C, Langefeld C, Hays L, Welch M, Bild D, Ford E, Vinicor F (1993). "Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus. A randomized, controlled trial". Ann Intern Med. 119 (1): 36–41. PMID 8498761.
  2. Hunt D. "Foot ulcers and amputations in diabetes". Clin Evid: 455–62. PMID 16620415. Text " based on September 2005 search" ignored (help)
  3. "Scope: Management of type 2 diabetes: prevention and management of foot problems (update)" (PDF). Clinical Guidelines and Evidence Review for Type 2 Diabetes: Prevention and Management of Foot Problems. National Institute for Health and Clinical Excellence. 20 February 2003. Retrieved 2007-12-04.
  4. Spencer S. "Pressure relieving interventions for preventing and treating diabetic foot ulcers". Cochrane Database Syst Rev: CD002302. doi:10.1002/14651858.CD002302. PMID 10908550.
  5. 5.0 5.1 5.2 Reiber GE, Smith DG, Wallace C, Sullivan K, Hayes S, Vath C; et al. (2002). "Effect of therapeutic footwear on foot reulceration in patients with diabetes: a randomized controlled trial". JAMA. 287 (19): 2552–8. PMID 12020336.
  6. Uccioli L, Faglia E, Monticone G, Favales F, Durola L, Aldeghi A, Quarantiello A, Calia P, Menzinger G (1995). "Manufactured shoes in the prevention of diabetic foot ulcers". Diabetes Care. 18 (10): 1376–8. PMID 8721941.
  7. 7.0 7.1 McCabe CJ, Stevenson RC, Dolan AM (1998). "Evaluation of a diabetic foot screening and protection programme". Diabet Med. 15 (1): 80–4. doi:10.1002/(SICI)1096-9136(199801)15:1<80::AID-DIA517>3.0.CO;2-K. PMID 9472868.
  8. 8.0 8.1 Lincoln NB, Radford KA, Game FL, Jeffcoate WJ (2008). "Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial". Diabetologia. 51 (11): 1954–61. doi:10.1007/s00125-008-1110-0. PMID 18758747.

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