Diabetic foot natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
[[Diabetic foot]] is a known [[Complication (medicine)|complication]] of [[diabetes]]. [[diabetes|Diabetic]] [[patients]] who are at risk of [[foot]] [[ulcer|ulceration]], develop [[diabetic foot]] which may get [[infection|infected]] later. The healing process of [[diabetic foot]] usually takes a long time (2-5 months) with proper [[treatment]]. The final state of [[diabetic foot]] is a [[necrosis|necrotic]] [[foot]]. The [[wound healing]] process can get prolonged in [[patients]] with high elevated [[body mas-s index]] or [[osteomyelitis]]. [[Diabetic foot]] [[ulcer]] can cause numerous [[Complication (medicine)|complications]], such as [[sepsis]], [[osteomyelitis]], [[gangrene]], lower [[Limb (anatomy)|limb]] [[amputation]] and death. Chance of [[amputation]] is increased with factors such as [[Ageing|old age]], [[peripheral vascular disease]] ([[Peripheral vascular disease|PAD]]), transcutaneous [[oxygen]] reduction, poor [[Diabetes management|glycemic control]], being on [[dialysis]] and [[osteomyelitis]]. If left untreated [[prognosis]] could be very bad and it eventually can lead to death. [[Male|Male gender]], [[Ageing|old age]], [[peripheral vascular disease]] and concurrent [[chronic renal failure]] are related to higher rate of death. The presence of a single [[ulcer]] is associated with a particularly good [[prognosis]] among [[patients]] with [[diabetic foot]], compared to multiple [[ulcers]]. [[Diabetes management|Glycemic control]] improvement, [[treatment]] of [[neuropathy]] and immediate [[treatment]] of [[ulcers]] improves the [[prognosis]].
[[Diabetic foot]] is a known [[Complication (medicine)|complication]] of [[diabetes]]. [[diabetes|Diabetic]] [[patients]] who are at risk of [[foot]] [[ulcer|ulceration]], develop [[diabetic foot]] which may get [[infection|infected]] later. The healing process of [[diabetic foot]] usually takes a long time (2-5 months) with proper [[treatment]]. The final state of [[diabetic foot]] is a [[necrosis|necrotic]] [[foot]]. The [[wound healing]] process can get prolonged in [[patients]] with high elevated [[body mas-s index]] or [[osteomyelitis]]. [[Diabetic foot]] [[ulcer]] can cause numerous [[Complication (medicine)|complications]], such as [[sepsis]], [[osteomyelitis]], [[gangrene]], lower [[Limb (anatomy)|limb]] [[amputation]] and death. Chance of [[amputation]] is increased with factors such as [[Ageing|old age]], [[peripheral vascular disease]] ([[Peripheral vascular disease|PAD]]), transcutaneous [[oxygen]] reduction, poor [[Diabetes management|glycemic control]], being on [[dialysis]] and [[osteomyelitis]]. If left untreated [[prognosis]] could be very bad and it eventually can lead to death. [[Male|Male gender]], [[Ageing|old age]], [[peripheral vascular disease]] and concurrent [[chronic renal failure]] are related to higher rate of death. The presence of a single [[ulcer]] is associated with a particularly good [[prognosis]] among [[patients]] with [[diabetic foot]], compared to multiple [[ulcers]]. [[Diabetes management|Glycemic control]] improvement, [[treatment]] of [[neuropathy]] and immediate [[treatment]] of [[ulcers]] improve the [[prognosis]].
==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
===Natural History===
===Natural History===
*[[Diabetic foot]] as a known [[Complication (medicine)|complication]] of [[diabetes]] is more related to [[diabetes|diabetes mellitus type 2]], compared to [[diabetes|type 1 diabetes]].<ref name="pmid27585063">{{cite journal| author=Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y| title=Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis †. | journal=Ann Med | year= 2017 | volume= 49 | issue= 2 | pages= 106-116 | pmid=27585063 | doi=10.1080/07853890.2016.1231932 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27585063  }} </ref><ref name="pmid23124278">{{cite journal| author=Moura Neto A, Zantut-Wittmann DE, Fernandes TD, Nery M, Parisi MC| title=Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients. | journal=Endocrine | year= 2013 | volume= 44 | issue= 1 | pages= 119-24 | pmid=23124278 | doi=10.1007/s12020-012-9829-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23124278  }} </ref>
*[[Diabetic foot]] as a known [[Complication (medicine)|complication]] of [[diabetes]] is more related to [[diabetes|diabetes mellitus type 2]], compared to [[diabetes|type 1 diabetes]].<ref name="pmid27585063">{{cite journal| author=Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y| title=Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis †. | journal=Ann Med | year= 2017 | volume= 49 | issue= 2 | pages= 106-116 | pmid=27585063 | doi=10.1080/07853890.2016.1231932 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27585063  }} </ref><ref name="pmid23124278">{{cite journal| author=Moura Neto A, Zantut-Wittmann DE, Fernandes TD, Nery M, Parisi MC| title=Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients. | journal=Endocrine | year= 2013 | volume= 44 | issue= 1 | pages= 119-24 | pmid=23124278 | doi=10.1007/s12020-012-9829-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23124278  }} </ref>
*[[Diabetic foot]] [[ulcer]]s heals slowly and it usually take between 2-5 months to completely heal with proper [[treatment]].<ref name="Nabuurs-FranssenHuijberts2005">{{cite journal|last1=Nabuurs-Franssen|first1=M. H.|last2=Huijberts|first2=M. S. P.|last3=Nieuwenhuijzen Kruseman|first3=A. C.|last4=Willems|first4=J.|last5=Schaper|first5=N. C.|title=Health-related quality of life of diabetic foot ulcer patients and their caregivers|journal=Diabetologia|volume=48|issue=9|year=2005|pages=1906–1910|issn=0012-186X|doi=10.1007/s00125-005-1856-6}}</ref>
*[[Diabetic foot]] [[ulcer]]s heals slowly and it usually take between 2-5 months to completely heal with proper [[treatment]].<ref name="Nabuurs-FranssenHuijberts2005">{{cite journal|last1=Nabuurs-Franssen|first1=M. H.|last2=Huijberts|first2=M. S. P.|last3=Nieuwenhuijzen Kruseman|first3=A. C.|last4=Willems|first4=J.|last5=Schaper|first5=N. C.|title=Health-related quality of life of diabetic foot ulcer patients and their caregivers|journal=Diabetologia|volume=48|issue=9|year=2005|pages=1906–1910|issn=0012-186X|doi=10.1007/s00125-005-1856-6}}</ref>
*[[diabetes|Diabetic]] [[patients]] who are at risk of [[foot]] [[ulcer|ulceration]], develop [[diabetic foot]] which may get infected later. The final state of [[diabetic foot]] is a [[necrosis|necrotic]] [[foot]].<ref name="pmid16740006">{{cite journal| author=Edmonds M| title=Diabetic foot ulcers: practical treatment recommendations. | journal=Drugs | year= 2006 | volume= 66 | issue= 7 | pages= 913-29 | pmid=16740006 | doi=10.2165/00003495-200666070-00003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16740006  }} </ref>
*[[diabetes|Diabetic]] [[patients]] who are at risk of [[foot]] [[ulcer|ulceration]], develop [[diabetic foot]] which may get infected later. The final state of [[diabetic foot]] is a [[necrosis|necrotic]] [[foot]].<ref name="pmid16740006">{{cite journal| author=Edmonds M| title=Diabetic foot ulcers: practical treatment recommendations. | journal=Drugs | year= 2006 | volume= 66 | issue= 7 | pages= 913-29 | pmid=16740006 | doi=10.2165/00003495-200666070-00003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16740006  }} </ref>
*Based on a study, factors such as elevated [[body mass index]] and [[osteomyelitis]] prolong the [[wound healing]] process.<ref name="pmid31118658">{{cite journal| author=Dutra LMA, Melo MC, Moura MC, Leme LAP, De Carvalho MR, Mascarenhas AN | display-authors=etal| title=Prognosis of the outcome of severe diabetic foot ulcers with multidisciplinary care. | journal=J Multidiscip Healthc | year= 2019 | volume= 12 | issue=  | pages= 349-359 | pmid=31118658 | doi=10.2147/JMDH.S194969 | pmc=6506632 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31118658  }} </ref>
*Based on a study, factors such as elevated [[body mass index]] and [[osteomyelitis]] prolong the [[wound healing]] process.<ref name="pmid31118658">{{cite journal| author=Dutra LMA, Melo MC, Moura MC, Leme LAP, De Carvalho MR, Mascarenhas AN | display-authors=etal| title=Prognosis of the outcome of severe diabetic foot ulcers with multidisciplinary care. | journal=J Multidiscip Healthc | year= 2019 | volume= 12 | issue=  | pages= 349-359 | pmid=31118658 | doi=10.2147/JMDH.S194969 | pmc=6506632 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31118658  }} </ref>
*If left untreated [[diabetes|diabetic]] [[ulcer]] may progress to [[infection]], [[sepsis]], or [[osteomyelitis]]. According to an estimate 20% of significant [[diabetic foot]] ulcers end up requiring an [[amputation]]. Untreated [[diabetic foot]] [[ulcer]] can lead to death of the affected individual.<ref name="pmid28614678">{{cite journal| author=Armstrong DG, Boulton AJM, Bus SA| title=Diabetic Foot Ulcers and Their Recurrence. | journal=N Engl J Med | year= 2017 | volume= 376 | issue= 24 | pages= 2367-2375 | pmid=28614678 | doi=10.1056/NEJMra1615439 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28614678  }} </ref>
*If left untreated [[diabetes|diabetic]] [[ulcer]] may progress to [[infection]], [[sepsis]], or [[osteomyelitis]]. According to an estimate 20% of significant [[diabetic foot]] ulcers end up requiring an [[amputation]].  


===Complications===
===Complications===
*[[Diabetic foot]] [[ulcer]] can cause numerous [[Complication (medicine)|complications]] including:<ref name="pmid28614678">{{cite journal| author=Armstrong DG, Boulton AJM, Bus SA| title=Diabetic Foot Ulcers and Their Recurrence. | journal=N Engl J Med | year= 2017 | volume= 376 | issue= 24 | pages= 2367-2375 | pmid=28614678 | doi=10.1056/NEJMra1615439 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28614678  }} </ref><ref name="pmid18647759">{{cite journal| author=Gardner SE, Frantz RA| title=Wound bioburden and infection-related complications in diabetic foot ulcers. | journal=Biol Res Nurs | year= 2008 | volume= 10 | issue= 1 | pages= 44-53 | pmid=18647759 | doi=10.1177/1099800408319056 | pmc=3777233 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18647759  }} </ref><ref name="pmid22890823">{{cite journal| author=Brownrigg JR, Davey J, Holt PJ, Davis WA, Thompson MM, Ray KK et al.| title=The association of ulceration of the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis. | journal=Diabetologia | year= 2012 | volume= 55 | issue= 11 | pages= 2906-12 | pmid=22890823 | doi=10.1007/s00125-012-2673-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22890823  }} </ref><ref name="pmid17276208">{{cite journal| author=Rathur HM, Boulton AJ| title=The diabetic foot. | journal=Clin Dermatol | year= 2007 | volume= 25 | issue= 1 | pages= 109-20 | pmid=17276208 | doi=10.1016/j.clindermatol.2006.09.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17276208  }} </ref><ref name="pmid31118658">{{cite journal| author=Dutra LMA, Melo MC, Moura MC, Leme LAP, De Carvalho MR, Mascarenhas AN | display-authors=etal| title=Prognosis of the outcome of severe diabetic foot ulcers with multidisciplinary care. | journal=J Multidiscip Healthc | year= 2019 | volume= 12 | issue=  | pages= 349-359 | pmid=31118658 | doi=10.2147/JMDH.S194969 | pmc=6506632 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31118658  }} </ref><ref name="pmid27213157">{{cite journal| author=Chammas NK, Hill RL, Edmonds ME| title=Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type. | journal=J Diabetes Res | year= 2016 | volume= 2016 | issue=  | pages= 2879809 | pmid=27213157 | doi=10.1155/2016/2879809 | pmc=4860228 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27213157  }} </ref><ref name="pmid22815299">{{cite journal| author=Morbach S, Furchert H, Gröblinghoff U, Hoffmeier H, Kersten K, Klauke GT | display-authors=etal| title=Long-term prognosis of diabetic foot patients and their limbs: amputation and death over the course of a decade. | journal=Diabetes Care | year= 2012 | volume= 35 | issue= 10 | pages= 2021-7 | pmid=22815299 | doi=10.2337/dc12-0200 | pmc=3447849 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22815299  }} </ref><ref name="pmid28465790">{{cite journal| author=Giurato L, Meloni M, Izzo V, Uccioli L| title=Osteomyelitis in diabetic foot: A comprehensive overview. | journal=World J Diabetes | year= 2017 | volume= 8 | issue= 4 | pages= 135-142 | pmid=28465790 | doi=10.4239/wjd.v8.i4.135 | pmc=5394733 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28465790  }} </ref>
*[[Diabetic foot]] [[ulcer]] can cause numerous [[Complication (medicine)|complications]] including:<ref name="pmid28614678">{{cite journal| author=Armstrong DG, Boulton AJM, Bus SA| title=Diabetic Foot Ulcers and Their Recurrence. | journal=N Engl J Med | year= 2017 | volume= 376 | issue= 24 | pages= 2367-2375 | pmid=28614678 | doi=10.1056/NEJMra1615439 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28614678  }} </ref><ref name="pmid18647759">{{cite journal| author=Gardner SE, Frantz RA| title=Wound bioburden and infection-related complications in diabetic foot ulcers. | journal=Biol Res Nurs | year= 2008 | volume= 10 | issue= 1 | pages= 44-53 | pmid=18647759 | doi=10.1177/1099800408319056 | pmc=3777233 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18647759  }} </ref><ref name="pmid22890823">{{cite journal| author=Brownrigg JR, Davey J, Holt PJ, Davis WA, Thompson MM, Ray KK et al.| title=The association of ulceration of the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis. | journal=Diabetologia | year= 2012 | volume= 55 | issue= 11 | pages= 2906-12 | pmid=22890823 | doi=10.1007/s00125-012-2673-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22890823  }} </ref><ref name="pmid17276208">{{cite journal| author=Rathur HM, Boulton AJ| title=The diabetic foot. | journal=Clin Dermatol | year= 2007 | volume= 25 | issue= 1 | pages= 109-20 | pmid=17276208 | doi=10.1016/j.clindermatol.2006.09.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17276208  }} </ref><ref name="pmid31118658">{{cite journal| author=Dutra LMA, Melo MC, Moura MC, Leme LAP, De Carvalho MR, Mascarenhas AN | display-authors=etal| title=Prognosis of the outcome of severe diabetic foot ulcers with multidisciplinary care. | journal=J Multidiscip Healthc | year= 2019 | volume= 12 | issue=  | pages= 349-359 | pmid=31118658 | doi=10.2147/JMDH.S194969 | pmc=6506632 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31118658  }} </ref><ref name="pmid27213157">{{cite journal| author=Chammas NK, Hill RL, Edmonds ME| title=Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type. | journal=J Diabetes Res | year= 2016 | volume= 2016 | issue=  | pages= 2879809 | pmid=27213157 | doi=10.1155/2016/2879809 | pmc=4860228 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27213157  }} </ref><ref name="pmid22815299">{{cite journal| author=Morbach S, Furchert H, Gröblinghoff U, Hoffmeier H, Kersten K, Klauke GT | display-authors=etal| title=Long-term prognosis of diabetic foot patients and their limbs: amputation and death over the course of a decade. | journal=Diabetes Care | year= 2012 | volume= 35 | issue= 10 | pages= 2021-7 | pmid=22815299 | doi=10.2337/dc12-0200 | pmc=3447849 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22815299  }} </ref><ref name="pmid28465790">{{cite journal| author=Giurato L, Meloni M, Izzo V, Uccioli L| title=Osteomyelitis in diabetic foot: A comprehensive overview. | journal=World J Diabetes | year= 2017 | volume= 8 | issue= 4 | pages= 135-142 | pmid=28465790 | doi=10.4239/wjd.v8.i4.135 | pmc=5394733 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28465790  }} </ref>
**[[Infection]]:
**[[Infection]]:
***[[Diabetes|Diabetic foot]] [[infection]] is the most common cause of [[Hospital|hospitalization]] in [[diabetes|diabetic]] [[patients]].  
***[[Diabetes|Diabetic foot]] [[infection]] is the most common cause of [[Hospital|hospitalization]] in [[diabetes|diabetic]] [[patients]].
**[[Sepsis]]
**[[Sepsis]]
**[[Osteomyelitis]]:
**[[Osteomyelitis]]:
***The following features of a [[diabetic foot]] [[ulcer]] increase the chance of [[osteomyelitis]] development:
***The following features of a [[diabetic foot]] [[ulcer]] increase the chance of [[osteomyelitis]] development:
****[[Ulcers]] larger than 2 centimeter  
****[[Ulcers]] larger than 2 centimeter
****[[Ulcers]] that last more than 1 week
****[[Ulcers]] that last more than 1 week
****[[Ulcers]] with positive probe to bone test
****[[Ulcers]] with positive probe to bone test
Line 46: Line 48:


===Prognosis===
===Prognosis===
*If left untreated [[prognosis]] could be very bad and it eventually can lead to death.<ref name="pmid28614678">{{cite journal| author=Armstrong DG, Boulton AJM, Bus SA| title=Diabetic Foot Ulcers and Their Recurrence. | journal=N Engl J Med | year= 2017 | volume= 376 | issue= 24 | pages= 2367-2375 | pmid=28614678 | doi=10.1056/NEJMra1615439 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28614678  }} </ref>
*If left untreated [[prognosis]] could be very bad and it eventually can lead to death.<ref name="pmid28614678">{{cite journal| author=Armstrong DG, Boulton AJM, Bus SA| title=Diabetic Foot Ulcers and Their Recurrence. | journal=N Engl J Med | year= 2017 | volume= 376 | issue= 24 | pages= 2367-2375 | pmid=28614678 | doi=10.1056/NEJMra1615439 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28614678  }} </ref>
*The 5 year risk of [[mortality rate|mortality]] in [[diabetes|diabetic]] [[patients]] with a [[foot]] [[ulcer]] is 2.5 times higher than [[diabetes|diabetic individuals]] without a [[foot]] [[ulcer]].<ref name="pmid28614678">{{cite journal| author=Armstrong DG, Boulton AJM, Bus SA| title=Diabetic Foot Ulcers and Their Recurrence. | journal=N Engl J Med | year= 2017 | volume= 376 | issue= 24 | pages= 2367-2375 | pmid=28614678 | doi=10.1056/NEJMra1615439 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28614678  }} </ref><ref name="ChammasHill2016">{{cite journal|last1=Chammas|first1=N. K.|last2=Hill|first2=R. L. R.|last3=Edmonds|first3=M. E.|title=Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type|journal=Journal of Diabetes Research|volume=2016|year=2016|pages=1–7|issn=2314-6745|doi=10.1155/2016/2879809}}</ref>
*The 5 year risk of [[mortality rate|mortality]] in [[diabetes|diabetic]] [[patients]] with a [[foot]] [[ulcer]] is 2.5 times higher than [[diabetes|diabetic individuals]] without a [[foot]] [[ulcer]].<ref name="pmid28614678">{{cite journal| author=Armstrong DG, Boulton AJM, Bus SA| title=Diabetic Foot Ulcers and Their Recurrence. | journal=N Engl J Med | year= 2017 | volume= 376 | issue= 24 | pages= 2367-2375 | pmid=28614678 | doi=10.1056/NEJMra1615439 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28614678  }} </ref><ref name="ChammasHill2016">{{cite journal|last1=Chammas|first1=N. K.|last2=Hill|first2=R. L. R.|last3=Edmonds|first3=M. E.|title=Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type|journal=Journal of Diabetes Research|volume=2016|year=2016|pages=1–7|issn=2314-6745|doi=10.1155/2016/2879809}}</ref>
Line 53: Line 56:
**[[Edema]]
**[[Edema]]
**[[Infection]]
**[[Infection]]
**Presence of other [[Comorbidity|comorbidities]]  
**Presence of other [[Comorbidity|comorbidities]]
*The presence of a single [[ulcer]] is associated with a particularly good [[prognosis]] among [[patients]] with [[diabetic foot]], compared to multiple [[ulcers]].<ref name="pmid29083500">{{cite journal| author=Ndosi M, Wright-Hughes A, Brown S, Backhouse M, Lipsky BA, Bhogal M | display-authors=etal| title=Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study. | journal=Diabet Med | year= 2018 | volume= 35 | issue= 1 | pages= 78-88 | pmid=29083500 | doi=10.1111/dme.13537 | pmc=5765512 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29083500  }} </ref>
*The presence of a single [[ulcer]] is associated with a particularly good [[prognosis]] among [[patients]] with [[diabetic foot]], compared to multiple [[ulcers]].<ref name="pmid29083500">{{cite journal| author=Ndosi M, Wright-Hughes A, Brown S, Backhouse M, Lipsky BA, Bhogal M | display-authors=etal| title=Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study. | journal=Diabet Med | year= 2018 | volume= 35 | issue= 1 | pages= 78-88 | pmid=29083500 | doi=10.1111/dme.13537 | pmc=5765512 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29083500  }} </ref>
*Modification of specific [[risk factors]] (such as [[Diabetes management|improving glycemic control]], [[treatment]] of [[neuropathy]] and immediate [[treatment]] of [[ulcers]]) improves the [[prognosis]] in a significant manner.<ref name="pmid33301344">{{cite journal| author=| title="Group therapy for schizophrenia: A meta-analysis": Correction to Burlingame et al. (2020). | journal=Psychotherapy (Chic) | year= 2020 | volume= 57 | issue= 4 | pages= 597 | pmid=33301344 | doi=10.1037/pst0000354 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33301344  }} </ref>
*Modification of specific [[risk factors]] (such as [[Diabetes management|improving glycemic control]], [[treatment]] of [[neuropathy]] and immediate [[treatment]] of [[ulcers]]) improves the [[prognosis]] in a significant manner.<ref name="pmid33301344">{{cite journal| author=| title="Group therapy for schizophrenia: A meta-analysis": Correction to Burlingame et al. (2020). | journal=Psychotherapy (Chic) | year= 2020 | volume= 57 | issue= 4 | pages= 597 | pmid=33301344 | doi=10.1037/pst0000354 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33301344  }} </ref>
*Three year [[mortality rate|mortality]] has been estimated 35-50% after [[amputation]] of the [[diabetes|diabetic]] [[foot]].<ref name="pmid31223342">{{cite journal| author=Ugwu E, Adeleye O, Gezawa I, Okpe I, Enamino M, Ezeani I| title=Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study. | journal=J Foot Ankle Res | year= 2019 | volume= 12 | issue=  | pages= 34 | pmid=31223342 | doi=10.1186/s13047-019-0345-y | pmc=6570910 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31223342  }} </ref>
*Three year [[mortality rate|mortality]] has been estimated 35-50% after [[amputation]] of the [[diabetes|diabetic]] [[foot]].<ref name="pmid31223342">{{cite journal| author=Ugwu E, Adeleye O, Gezawa I, Okpe I, Enamino M, Ezeani I| title=Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study. | journal=J Foot Ankle Res | year= 2019 | volume= 12 | issue=  | pages= 34 | pmid=31223342 | doi=10.1186/s13047-019-0345-y | pmc=6570910 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31223342  }} </ref>
*Based on different studies, [[toe]] [[pressure]] more than 55 mmHg is indicative for a better [[wound healing]] and therefore a better [[prognossis]]. In the contrary, [[toe]] [[pressure]] less than 30 mmHg in a [[diabetes|diabetic]] [[patient]] with [[diabetic foot]] is indicative of a severely defective [[wound healing]].<ref name="LepäntaloApelqvist2011">{{cite journal|last1=Lepäntalo|first1=M.|last2=Apelqvist|first2=J.|last3=Setacci|first3=C.|last4=Ricco|first4=J.-B.|last5=de Donato|first5=G.|last6=Becker|first6=F.|last7=Robert-Ebadi|first7=H.|last8=Cao|first8=P.|last9=Eckstein|first9=H.H.|last10=De Rango|first10=P.|last11=Diehm|first11=N.|last12=Schmidli|first12=J.|last13=Teraa|first13=M.|last14=Moll|first14=F.L.|last15=Dick|first15=F.|last16=Davies|first16=A.H.|title=Chapter V: Diabetic Foot|journal=European Journal of Vascular and Endovascular Surgery|volume=42|year=2011|pages=S60–S74|issn=10785884|doi=10.1016/S1078-5884(11)60012-9}}</ref><ref name="pmid1246689">{{cite journal| author=Raines JK, Darling RC, Buth J, Brewster DC, Austen WG| title=Vascular laboratory criteria for the management of peripheral vascular disease of the lower extremities. | journal=Surgery | year= 1976 | volume= 79 | issue= 1 | pages= 21-9 | pmid=1246689 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1246689  }} </ref>
*Based on different studies, [[toe]] [[pressure]] more than 55 mmHg is indicative for a better [[wound healing]] and therefore a better [[prognossis|prognosis]]. In the contrary, [[toe]] [[pressure]] less than 30 mmHg in a [[diabetes|diabetic]] [[patient]] with [[diabetic foot]] is indicative of a severely defective [[wound healing]].<ref name="LepäntaloApelqvist2011">{{cite journal|last1=Lepäntalo|first1=M.|last2=Apelqvist|first2=J.|last3=Setacci|first3=C.|last4=Ricco|first4=J.-B.|last5=de Donato|first5=G.|last6=Becker|first6=F.|last7=Robert-Ebadi|first7=H.|last8=Cao|first8=P.|last9=Eckstein|first9=H.H.|last10=De Rango|first10=P.|last11=Diehm|first11=N.|last12=Schmidli|first12=J.|last13=Teraa|first13=M.|last14=Moll|first14=F.L.|last15=Dick|first15=F.|last16=Davies|first16=A.H.|title=Chapter V: Diabetic Foot|journal=European Journal of Vascular and Endovascular Surgery|volume=42|year=2011|pages=S60–S74|issn=10785884|doi=10.1016/S1078-5884(11)60012-9}}</ref><ref name="pmid1246689">{{cite journal| author=Raines JK, Darling RC, Buth J, Brewster DC, Austen WG| title=Vascular laboratory criteria for the management of peripheral vascular disease of the lower extremities. | journal=Surgery | year= 1976 | volume= 79 | issue= 1 | pages= 21-9 | pmid=1246689 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1246689  }} </ref>


==References==
==References==

Revision as of 18:27, 29 July 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2] Vishnu Vardhan Serla M.B.B.S. [3] Usama Talib, BSc, MD [4]

Overview

Diabetic foot is a known complication of diabetes. Diabetic patients who are at risk of foot ulceration, develop diabetic foot which may get infected later. The healing process of diabetic foot usually takes a long time (2-5 months) with proper treatment. The final state of diabetic foot is a necrotic foot. The wound healing process can get prolonged in patients with high elevated body mas-s index or osteomyelitis. Diabetic foot ulcer can cause numerous complications, such as sepsis, osteomyelitis, gangrene, lower limb amputation and death. Chance of amputation is increased with factors such as old age, peripheral vascular disease (PAD), transcutaneous oxygen reduction, poor glycemic control, being on dialysis and osteomyelitis. If left untreated prognosis could be very bad and it eventually can lead to death. Male gender, old age, peripheral vascular disease and concurrent chronic renal failure are related to higher rate of death. The presence of a single ulcer is associated with a particularly good prognosis among patients with diabetic foot, compared to multiple ulcers. Glycemic control improvement, treatment of neuropathy and immediate treatment of ulcers improve the prognosis.

Natural History, Complications, and Prognosis

Natural History

Complications

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References

  1. ↑ Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y (2017). "Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis †". Ann Med. 49 (2): 106–116. doi:10.1080/07853890.2016.1231932. PMID 27585063.
  2. ↑ Moura Neto A, Zantut-Wittmann DE, Fernandes TD, Nery M, Parisi MC (2013). "Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients". Endocrine. 44 (1): 119–24. doi:10.1007/s12020-012-9829-2. PMID 23124278.
  3. ↑ Nabuurs-Franssen, M. H.; Huijberts, M. S. P.; Nieuwenhuijzen Kruseman, A. C.; Willems, J.; Schaper, N. C. (2005). "Health-related quality of life of diabetic foot ulcer patients and their caregivers". Diabetologia. 48 (9): 1906–1910. doi:10.1007/s00125-005-1856-6. ISSN 0012-186X.
  4. ↑ Edmonds M (2006). "Diabetic foot ulcers: practical treatment recommendations". Drugs. 66 (7): 913–29. doi:10.2165/00003495-200666070-00003. PMID 16740006.
  5. ↑ 5.0 5.1 Dutra LMA, Melo MC, Moura MC, Leme LAP, De Carvalho MR, Mascarenhas AN; et al. (2019). "Prognosis of the outcome of severe diabetic foot ulcers with multidisciplinary care". J Multidiscip Healthc. 12: 349–359. doi:10.2147/JMDH.S194969. PMC 6506632 Check |pmc= value (help). PMID 31118658.
  6. ↑ 6.0 6.1 6.2 Armstrong DG, Boulton AJM, Bus SA (2017). "Diabetic Foot Ulcers and Their Recurrence". N Engl J Med. 376 (24): 2367–2375. doi:10.1056/NEJMra1615439. PMID 28614678.
  7. ↑ Gardner SE, Frantz RA (2008). "Wound bioburden and infection-related complications in diabetic foot ulcers". Biol Res Nurs. 10 (1): 44–53. doi:10.1177/1099800408319056. PMC 3777233. PMID 18647759.
  8. ↑ Brownrigg JR, Davey J, Holt PJ, Davis WA, Thompson MM, Ray KK; et al. (2012). "The association of ulceration of the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis". Diabetologia. 55 (11): 2906–12. doi:10.1007/s00125-012-2673-3. PMID 22890823.
  9. ↑ 9.0 9.1 Rathur HM, Boulton AJ (2007). "The diabetic foot". Clin Dermatol. 25 (1): 109–20. doi:10.1016/j.clindermatol.2006.09.015. PMID 17276208.
  10. ↑ Chammas NK, Hill RL, Edmonds ME (2016). "Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type". J Diabetes Res. 2016: 2879809. doi:10.1155/2016/2879809. PMC 4860228. PMID 27213157.
  11. ↑ Morbach S, Furchert H, Gröblinghoff U, Hoffmeier H, Kersten K, Klauke GT; et al. (2012). "Long-term prognosis of diabetic foot patients and their limbs: amputation and death over the course of a decade". Diabetes Care. 35 (10): 2021–7. doi:10.2337/dc12-0200. PMC 3447849. PMID 22815299.
  12. ↑ Giurato L, Meloni M, Izzo V, Uccioli L (2017). "Osteomyelitis in diabetic foot: A comprehensive overview". World J Diabetes. 8 (4): 135–142. doi:10.4239/wjd.v8.i4.135. PMC 5394733. PMID 28465790.
  13. ↑ 13.0 13.1 Chammas, N. K.; Hill, R. L. R.; Edmonds, M. E. (2016). "Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type". Journal of Diabetes Research. 2016: 1–7. doi:10.1155/2016/2879809. ISSN 2314-6745.
  14. ↑ Schaper, N. C.; Andros, G.; Apelqvist, J.; Bakker, K.; Lammer, J.; Lepantalo, M.; Mills, J. L.; Reekers, J.; Shearman, C. P.; Zierler, R. E.; Hinchliffe, R. J. (2012). "Diagnosis and treatment of peripheral arterial disease in diabetic patients with a foot ulcer. A progress report of the International Working Group on the Diabetic Foot". Diabetes/Metabolism Research and Reviews. 28: 218–224. doi:10.1002/dmrr.2255. ISSN 1520-7552.
  15. ↑ Ndosi M, Wright-Hughes A, Brown S, Backhouse M, Lipsky BA, Bhogal M; et al. (2018). "Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study". Diabet Med. 35 (1): 78–88. doi:10.1111/dme.13537. PMC 5765512. PMID 29083500.
  16. ↑ ""Group therapy for schizophrenia: A meta-analysis": Correction to Burlingame et al. (2020)". Psychotherapy (Chic). 57 (4): 597. 2020. doi:10.1037/pst0000354. PMID 33301344 Check |pmid= value (help).
  17. ↑ Ugwu E, Adeleye O, Gezawa I, Okpe I, Enamino M, Ezeani I (2019). "Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study". J Foot Ankle Res. 12: 34. doi:10.1186/s13047-019-0345-y. PMC 6570910 Check |pmc= value (help). PMID 31223342.
  18. ↑ Lepäntalo, M.; Apelqvist, J.; Setacci, C.; Ricco, J.-B.; de Donato, G.; Becker, F.; Robert-Ebadi, H.; Cao, P.; Eckstein, H.H.; De Rango, P.; Diehm, N.; Schmidli, J.; Teraa, M.; Moll, F.L.; Dick, F.; Davies, A.H. (2011). "Chapter V: Diabetic Foot". European Journal of Vascular and Endovascular Surgery. 42: S60–S74. doi:10.1016/S1078-5884(11)60012-9. ISSN 1078-5884.
  19. ↑ Raines JK, Darling RC, Buth J, Brewster DC, Austen WG (1976). "Vascular laboratory criteria for the management of peripheral vascular disease of the lower extremities". Surgery. 79 (1): 21–9. PMID 1246689.
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