References

Alex R, Ratnaraj B, Winston B Risk factors for foot ulcers in patients with diabetes mellitus—a short report from Vellore, South India. Indian J Community Med. 2010; (35)183-185 https://doi.org/10.4103%2F0970-0218.62582

Atkin L, Tansley J, Stephenson J Diabetic foot ulceration: the impact of oedema. Wounds UK. 2018; 14:(1)1-9

Armstrong DG, Boulton AJM, Bus SA Diabetic foot ulcers and their recurrence. N Engl J Med. 2017; 376:(24)2367-2375 https://doi.org/10.1056/nejmra1615439

Arosi I, Hiner G, Rajbhandari S Pathogenesis and treatment of callus in diabteic foot. Curr Diabetes Rev. 2016; 12:(3)179-183 https://doi.org/10.2174/1573399811666150609160219

British Association of Parenteral and Enteral Nutrition. Malnutrition Universal Screening Tool (MUST). 2020. https//www.bapen.org.uk/screening-and-must/must/must-toolkit/the-must-itself (accessed 29 January 2024)

Canedo JR, Miller ST, Schlundt D, Fadden MK, Sanderson M Racial/ethnic disparities in diabetes quality of care: the role of healthcare access and socioeconomic status. J Racial Ethn Health Disparities. 2018; 5:(1)7-14 https://doi.org/10.1007/s40615-016-0335-8

Centers for Disease Control and Prevention. National diabetes statistics report. 2022. https//www.cdc.gov/diabetes/data/statistics-report/index.html (accessed 29 January 2024)

Dietrich I, Braga GA, de Melo FG, da Costa Silva Silva ACC The diabetic foot as a proxy for cardiovascular events and mortality review. Curr Atheroscler Rep. 2017; 19:(11) https://doi.org/10.1007/s11883-017-0680-z

Dumville JC, Lipsky BA, Hoey C, Cruciani M, Fiscon M, Xia J Topical antimicrobial agents for treating foot ulcers in people with diabetes. Cochrane Database Syst Rev. 2017; 6:(6) https://doi.org/10.1002/14651858.cd011038.pub2

Goldman MP, Clark CJ, Craven TE Effect of intensive glycemic control on risk of lower extremity amputation. J Am Coll Surg. 2018; 227:(6)596-604 https://doi.org/10.1016/j.jamcollsurg.2018.09.021

Hess CT Comprehensive patient and wound assessments. Adv Skin Wound Care. 2019; 32:(6)287-288 https://doi.org/10.1097/01.asw.0000558514.64758.7f

Høyer C, Sandermann J, Petersen LJ The toe-brachial index in the diagnosis of peripheral arterial disease. J Vasc Surg. 2013; 58:(1)231-238 https://doi.org/10.1016/j.jvs.2013.03.044

Meloni M., Izzo V., Giurato L., Lazaro-Martinez J., Ucciolo L Prevalence, clinical aspects and outcomes in a large cohort of persons with diabetic foot disease: comparison between neuropathic and ischemic ulcers. J Clin Med. 2020; 9:(6) https://doi.org/10.3390%2Fjcm9061780

Mitchell A Skin assessment in adults. Br J Nurs. 2022; 31:(5)274-278 https://doi.org/10.12968/bjon.2022.31.5.274

National Institute for Health and Care Excellence. Diabetic foot problems: prevention and management (NG19). 2019. https//www.nice.org.uk/guidance/ng19 (accessed 29 January 2024)

National Institute for Health and Care Excellence. Antimicrobial prescribing guidelines. 2020. https//www.nice.org.uk/about/whatwe-do/our-programmes/nice-guidance/antimicrobialprescribing-guidelines (accessed 29 January 2024)

National Institute for Health and Care Excellence. Leg ulcer—venous. 2020. https//cks.nice.org.uk/leg-ulcervenous (accessed 29 January 2024)

Ndip A, Lavery L, Boulton A Diabetic foot disease in people with advanced nephropathy and those on renal dialysis. Curr Diab Rep. 2010; 10:(4)283-290 https://doi.org/10.1007/s11892-010-0128-0

Ouyang W, Jia Y, Lingli J Risk factors of diabetic foot ulcer in patients with type 2 diabetes: a retrospective cohort study. J Foot Ankle Res. 2021; 16 https://doi.org/10.1186/s13047-023-00616-0

Diabetic ulcer. 2023. https//www.ncbi.nlm.nih.gov/books/NBK499887/ (accessed 29 January 2024)

Park S, Choi C, Ha YI, Yang H Utility of toe-brachial index for diagnosis of peripheral arterial disease. Arch Plast Surg. 2012; 39:(3)227-231 https://doi.org/10.5999/aps.2012.39.3.227

Schaper NC, van Netten JJ, Apelqvist J Practical guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev. 2020; 36:(S1) https://doi.org/10.1002/dmrr.3266

IWGDF guidelines on the prevention and management of diabetic-related foot disease. 2023. https//iwgdfguidelines.org/wp-content/uploads/2023/07/IWGDF-Guidelines-2023.pdf (accessed 2 February 2024)

Senneville E, Alabalawi Z, van Asten SA IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF/IDSA 2023). Clinical Infectious Diseases. 2023; https://doi.org/10.1093/cid/ciad527

Tatulashvili S, Fagherazzi G, Dow C, Cohen R, Fosse S, Bihan H Socioeconomic inequalities and type 2 diabetes complications: a systematic review. Diabetes Metab. 2020; 46:(2)89-99 https://doi.org/10.1016/j.diabet.2019.11.001

Wilson M Understanding the basics of wound assessment. Wound Essentials. 2012; 7:(2)8-12

Winter GD Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature. 1962; 193:(4812)293-294 https://doi.org/10.1038/193293a0

Wounds UK. Quick guide: times model of wound bed preparation. 2017. https//wounds-uk.com/quick-guides/quick-guide-times-model-of-wound-bed-preparation/ (accessed 2 February 2024)

Wounds UK. Best practice statement: antimicrobial stewardship strategies for wound management. 2020. https//wounds-uk.com/best-practice-statements/best-practice-statement-antimicrobial-stewardship-strategies-wound-management/ (accessed 29 January 2024)

Yotsu R, Pham N, Oe M Comparison of characteristics and healing course of diabetic foot ulcers by etiological classification: neuropathic, ischemic, and neuro-ischemic type. J Diabetes Complications. 2014; 28:(4)528-535 https://doi.org/10.1016/j.jdiacomp.2014.03.013

Zhang GQ, Canner JK, Kayssi A, Abularrage CJ, Hicks CW Geographical socioeconomic disadvantage is associated with adverse outcomes following major amputation in diabetic patients. J Vasc Surg. 2021; 74:(4)1317-1326.e1 https://doi.org/10.1016/j.jvs.2021.03.033

Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med. 2017; 49:(2)106-116 https://doi.org/10.1080/07853890.2016.1231932

Assessment of diabetic foot ulcers: back to basics

22 February 2024
Volume 33 · Issue 4

Abstract

Diabetic foot ulceration affects up to 34% of the global diabetic population as a result of poor glycaemic control. Complications resulting from diabetic foot ulceration can be complex, expensive and challenging. It is important for risk factors to be recognised early and for regular assessment to take place. Streamlining a coordinated approach that enhances communication and guides treatment approaches can help to improve wound outcomes.

It is estimated that diabetes affects 537 million people worldwide and, as a result of poor glycaemic control, diabetic foot ulceration affects up to 34% of the global diabetic population (Schaper et al, 2020). The impact of complications resulting from diabetic foot ulceration can be complex, expensive and challenging. It is important for risk factors to be recognised early and for regular assessment to take place. Streamlining a coordinated approach that enhances communication and guides treatment can help to improve wound outcomes. This is a back-to-basics paper on the assessment of diabetic foot ulcers (DFUs) for clinical practice.

Poorly controlled diabetes frequently results in complications that predominantly affect the lower limbs, presenting complex and expensive challenges. One of the most typical complications associated with uncontrolled diabetes is the development of DFUs. It is estimated that between 19% and 34% of the global diabetic population will experience a DFU in their lifetime (Armstrong et al, 2017), with the global prevalence being higher among patients with type 2 diabetes mellitus (T2DM). This discrepancy may reflect the younger age, longer disease duration and limitations in research specific to cohorts of people with type 1 diabetes (Zhang et al, 2017).

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