Skip to main content

Advertisement

Log in

Management of Diabetic Foot Ulcers

  • Dermatology and Wound Care (M Reddy, Section Editor)
  • Published:
Current Geriatrics Reports Aims and scope Submit manuscript

Abstract

Diabetes is an increasing urgent global health issue, with an increasing prevalence in those aged 65 or over. Diabetic foot ulcers (DFUs) are a common complication, affecting up to 15 % of those diagnosed with diabetes; they can result in loss of employment, have a significant decrease on quality of life, may lead to limb loss and are costly to healthcare systems. In this paper, we discuss the recent advances in the various management options for diabetic foot ulcers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Bakker K, Apelqvist J, Schaper NC, On behalf of the International Working Group on Diabetic Foot Editorial Board. Practical guidelines on the management and prevention of the diabetic foot 2011. Diabetes Metab Res Rev. 2012;28 Suppl 1:225–31. The basic principles of prevention and treatment of diabetic foot disease described in these guidelines are based on the International Consensus on the Diabetic Foot.

    Article  PubMed  Google Scholar 

  2. Diabetes UK. The State of the Nation 2014: Diabetes in 2014. London. Diabetes UK, 2014. http://www.diabetes.org.uk/Documents/About%20Us/What%20we%20say/State%20of%20the%20nation%202014.pdf Accessed 29.01.15

  3. Centre for Disease Control and Prevention. National diabetes statistics report, 2104. Atlanta. Centre for Disease Control and Prevention, 2014. http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf Accessed 29.01.15

  4. Singh N, Armstrong D, Lipsky B. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293:271–8.

    Article  Google Scholar 

  5. Reiber GE. Epidemiology of foot ulcers and amputations in the diabetic foot. In: Bowker JH, Pfeifer MA, editors. The Diabetic Foot. St Louis: Mosby; 2001. p. 13–32.

    Google Scholar 

  6. Kerr M. Foot care for people with diabetes: the economic case for change. NHS Diabetes and Kidney Care, 2012.

  7. Armstrong DG, Lavery LA, et al. Activity patterns of patients with diabetic foot ulcers: patients with active ulcers may not adhere to a standard pressure offloading regimen. Diabetes Care. 2003;26:2595–7.

    Article  PubMed  Google Scholar 

  8. Mueller MJ, Diamond JE, Sinacore DR, et al. Total contact casting in treatment of diabetic plantar ulcers. Diabetes Care. 1989;12(6):384–8.

    Article  CAS  PubMed  Google Scholar 

  9. Ganguly S, Chakraborty K, Mandal PJ, et al. A comparative study between total contact casting and conventional dressings in the non-surgical management of diabetic plantar foot ulcers. J Indian Med Assoc. 2008;106:237–9.

    PubMed  Google Scholar 

  10. Armstrong DG, Nguyen HC, Lavery LA, et al. Off-loading the diabetic foot wound: a randomized clinical trial. Diabetes Care. 2001;24(6):1019–22.

    Article  CAS  PubMed  Google Scholar 

  11. Armstrong DG, Lavery LA, Wu S, Boulton AJM. Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: a randomized controlled trial. Diabetes Care. 2005;28(3):551–4.

    Article  PubMed  Google Scholar 

  12. Caravaggi C, Sganzaroli A, Fabbi M, et al. Nonwindowed nonremovable fiberglass off-loading cast versus removable pneumatic cast (AircastXP Diabetic Walker) in the treatment of neuropathic noninfected plantar ulcers: a randomized prospective trial. Diabetes Care. 2007;30(10):2577–8.

    Article  PubMed  Google Scholar 

  13. Piaggesi A, Macchiarini S, Rizzo L, et al. An off-the-shelf instant contact casting device for the management of diabetic foot ulcers: a randomized prospective trial versus traditional fiberglass cast. Diabetes Care. 2007;30(3):586–90.

    Article  PubMed  Google Scholar 

  14. Faglia E, Caravaggi C, Clerici G, et al. Effectiveness of removable walker cast versus nonremovable fiberglass off-bearing cast in the healing of diabetic plantar foot ulcer: a randomized controlled trial. Diabetes Care. 2010;33(7):1419–23.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Lewis J, Lipp A. Pressure-relieving interventions for treating diabetic foot ulcers. Cochrane Database Syst Rev 2013, Issue 1. Art. No.: CD002302. doi: 10.1002/14651858.CD002302.pub2.

  16. Ubbink DT, Westerbos SJ, Nelson EA, Vermeulen H. A systematic review of topical negative pressure therapy for acute and chronic wounds. Br J Surg. 2008;95:685–92.

    Article  CAS  PubMed  Google Scholar 

  17. Blume PA, Walters J, Payne W, et al. Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial. Diabetes Care. 2008;31(4):631–6.

    Article  PubMed  Google Scholar 

  18. Novinscak T, Zvorc M, Trojko S, et al. Comparison of cost-benefit of the three methods of diabetic ulcer treatment: dry, moist and negative pressure. Acta Med Croatica. 2010;64 Suppl 1:113–5.

    Google Scholar 

  19. Karatepe O, Eken I, Acet E, et al. Vacuum assisted closure improves the quality of life in patients with diabetic foot. Acta Chir Belg. 2011;111(5):298–302.

    CAS  PubMed  Google Scholar 

  20. Mody GN, Nirmal IA, Duraisamy S, Perakath B. A blinded, prospective, randomized controlled trial of topical negative pressure wound closure in India. Ostomy Wound Manage. 2008;54(12):36–46.

    PubMed  Google Scholar 

  21. Londahl M. Hyperbaric oxygen therapy as adjunctive treatment of diabetic foot ulcers. Med Clin N Am. 2013;97:957–80.

    Article  PubMed  Google Scholar 

  22. Kranke P, Bennett M, Martyn-St James M, et al. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev. 2012;4:CD004123.

    PubMed  Google Scholar 

  23. Ma L, Li P, Shi Z, et al. A prospective, randomized, controlled study of hyperbaric oxygen therapy: effects on healing and oxidative stress of ulcer tissue in patients with a diabetic foot ulcer. Ostomy Wound Manage. 2013;59(3):18–24.

    PubMed  Google Scholar 

  24. O’Reilly D, Pasricha A, Campbell K, Burke, et al. Hyperbaric oxygen therapy for diabetic ulcers: systematic review and meta-analysis. Int J Technol Assess Health Care. 2013;29(3):269–81.

    Article  PubMed  Google Scholar 

  25. Game FL, Hinchliffe RJ, Apelqvist J, et al. A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev. 2012;28 Suppl 1:119–41.

    Article  PubMed  Google Scholar 

  26. Steed DL, Donohoe D, Webster MW, Lindsley L, Diabetic ulcer study group. Effect of extensive debridement and treatment on healing of diabetic foot ulcers. J Am Coll Surg. 1996;183:61–4.

    CAS  PubMed  Google Scholar 

  27. Edwards J, Stapley S. Debridement of diabetic foot ulcers. Cochrane Database Syst Rev. 2010;1:CD003556. doi:10.1002/14651858.

    PubMed  Google Scholar 

  28. Gray D, Acton C, Chadwick P, et al. Consensus guidance for the use of debridement techniques in the UK 2011; 7: 77–84.

  29. Ennis WJ, Valdes W, Gainer M, Meneses P. Evaluation of clinical effectiveness of MIST ultrasound for the healing of chronic wounds. Adv Skin Wound Care. 2006;19:437–46.

    Article  PubMed  Google Scholar 

  30. Wounds UK. Use of the larvae from the Greenbottle fly Wounds UK. Effective debridement in a changing NHS: a UK consensus. London: Wounds UK, 2013. Available from: www.wounds-uk.com. Accessed 29.01.15.

  31. Jensen JL, Seeley J, Gillin B. Diabetic foot ulcerations: a controlled, randomized comparison of two moist wound healing protocols: Carrasyn hydrogel wound dressing and wet-to-moist saline gauze. Adv Wound Care. 1998;11(7):1–4.

    CAS  PubMed  Google Scholar 

  32. D’Hemecourt PA, Smiell JM, Karim MR. Sodium carboxymethyl cellulose aqueous-based gel vs becaplermin gel in patients with nonhealing lower extremity diabetic ulcers. Wounds. 1998;10(3):69–75.

    Google Scholar 

  33. Gregg EW, Sorlie P, Paulose-Ram R, et al. Prevalence of lower-extremity disease in the US adult population >=40 years of age with and without diabetes: 1999–2000 national health and nutrition examination survey. Diabetes Care. 2004;27:1591–7.

    Article  PubMed  Google Scholar 

  34. Dolan NG, Lui K, Criqui MH, et al. Peripheral arterial disease, diabetes, and reduced lower extremity functioning. Diabetes Care. 2002;25:113–20.

    Article  PubMed  Google Scholar 

  35. Mayfield JA, Reiber GE, Sanders LJ, et al. Preventative foot care in diabetes. Diabetes Care. 2004;27:S63–4.

    Article  PubMed  Google Scholar 

  36. Norgen L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45:S5–67.

    Article  Google Scholar 

  37. Faglia E, Dalla Paola L, Clerici G, et al. Peripheral angioplasty as the first-choice revascularization procedure in diabetic patients with critical limb ischaemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003. Eur J Vasc Endovasc Surg. 2005;29:620–7.

    Article  CAS  PubMed  Google Scholar 

  38. Sumpio BE, Forsythe RO, Ziegler KR, et al. Clinical implications of the angiosome model in peripheral arterial disease. J Vasc Surg. 2013;58:814–26.

    Article  PubMed  Google Scholar 

  39. Vogel TR, Dombrovskiy VY, Haser PB, Graham AM. Evaluating preventable adverse safety events after elective lower extremity procedures. J Vasc Surg. 2011;54:706–13.

    Article  PubMed  Google Scholar 

  40. Adam DJ, Beard JD, Cleveland T, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomized controlled trial. Lancet. 2005;366:1925–34.

    Article  CAS  PubMed  Google Scholar 

  41. Neville R, Singh N, Jamil T, et al. Revascularization for wound healing: are endovascular techniques as good as open bypass. Presented at the Society for Clinical Vascular Surgery 35th Annual Symposium, Naples, Florida, 2007.

  42. Piaggesi A, Schipani E, Campi F, et al. Conservative surgical approach versus non-surgical management for diabetic neuropathic foot ulcers: a randomised trial. Diabet Med. 1998;15:412–7.

    Article  CAS  PubMed  Google Scholar 

  43. Mueller MJ, Sinacore DR, Hastings MK, et al. Effect of Achilles tendon lengthening on neuropathic plantar ulcers: a randomized clinical trial. J Bone Joint Surg Am. 2003;85-A:1436–45.

    PubMed  Google Scholar 

  44. Fleischli JE, Anderson RB, Davis WH. Dorsiflexion metatarsal osteotomy for treatment of recalcitrant diabetic neuropathic ulcers. Foot Ankle Int. 1999;20:80–5.

    Article  CAS  PubMed  Google Scholar 

  45. Clemens MW, Parikh P, Hall MM, et al. External fixators as an adjunct to wound healing. Foot Ankle Clin. 2008;13:145–56.

    Article  PubMed  Google Scholar 

  46. Armstrong DG, Lavery LA, Vazquez JR, et al. Clinical efficacy of the first metatarsophalangeal joint arthroplasty as a curative procedure for hallux interphalangeal joint wounds in persons with diabetes. Diabetes Care. 2003;26:3284–7.

    Article  PubMed  Google Scholar 

  47. Foster AVM, Greenhill MT, Edmonds ME. Comparing two dressings in the treatment of diabetic foot ulcers. J Wound Care. 1994;3(5):224–8.

    Google Scholar 

  48. Jeffcoate WJ, Price PE, Phillips CJ, et al. Randomised controlled trial of the use of three dressing preparations in the management of chronic ulceration of the foot in diabetes. Health Technol Assess. 2009;13:1–110.

    CAS  PubMed  Google Scholar 

  49. Clever HU, Dreyer M. Comparing two wound dressings for the treatment of neuropathic diabetic foot ulcers. Proceedings of the 5th European Conference on Advances in Wound Management; 1995, 21–24 November; Harrogate, UK. Harrogate, UK, 1995: 201–3.

  50. Blackman JD, Senseng D, Quinn L, Mazzone T. Clinical evaluation of a semipermeable polymeric membrane dressing for the treatment of chronic diabetic foot ulcers. Diabetes Care. 1994;17(4):322–5.

    Article  CAS  PubMed  Google Scholar 

  51. Ahroni JH, Boyko EJ, Pecoraro RE. Diabetic foot ulcer healing: extrinsic vs intrinsic factors. Wounds. 1993;5(5):245–55.

    Google Scholar 

  52. Donaghue VM, Chrzan JS, Rosenblum BI, et al. Evaluation of a collagen-alginate wound dressing in the management of diabetic foot ulcers. Adv Wound Care. 1998;11(3):114–9.

    CAS  PubMed  Google Scholar 

  53. Lalau JD, Bresson R, Charpentier P, et al. Efficacy and tolerance of calcium alginate versus Vaseline gauze dressings in the treatment of diabetic foot lesions. Diabetes Metab. 2002;28(3):223–9.

    CAS  PubMed  Google Scholar 

  54. Jude EB, Apelqvist J, Spraul M, Martini J. Prospective randomized controlled study of Hydrofiber dressing containing ionic silver or calcium alginate dressings in non- ischaemic diabetic foot ulcers. Diabet Med. 2007;24(3):280–8.

    Article  CAS  PubMed  Google Scholar 

  55. Lawrence JC. The use of iodine as an antiseptic agent. J Wound Care. 1998;7:421–5.

    CAS  PubMed  Google Scholar 

  56. Michaels JA, Campbell B, King B, et al. Randomised controlled trial and cost-effectiveness analysis of silver-donating antimicrobial dressings for venous leg ulcers (VULCAN trial). Br J Surg. 2009;96:1147–56.

    Article  CAS  PubMed  Google Scholar 

  57. McDonnell G, Russell AD. Antiseptics and disinfectants: activity, action and resistance. Clin Microbiol Rev. 1999;12:147–79.

    CAS  PubMed Central  PubMed  Google Scholar 

  58. Cutting KF. Honey and contemporary wound care: an overview. Ostomy Wound Manage. 2007;53:49–54.

    PubMed  Google Scholar 

  59. Jull AB, Cullum N, Dumville JC, Westby MJ, Deshpande S, Walker N. Honey as a topical treatment for wounds. Cochrane Database Syst Rev. 2015;3:CD005083 [Epub ahead of print].

    PubMed  Google Scholar 

  60. Dumville JC, Deshpande S, O’Meara S, Speak K. Hydrocolloid dressings for healing diabetic foot ulcers. Cochrane Database Syst Rev. 2013;8:CD009099. doi:10.1002/14651858.CD009099.pub3.

    PubMed  Google Scholar 

  61. Vermeulen H, Ubbink DT, de Zwart F, et al. Preferences of patients, doctors and nurses regarding wound dressing characteristics: a conjoint analysis. Wound Repair Regen. 2007;15:302–7.

    Article  PubMed  Google Scholar 

  62. Dumville JC, O’Meara S, Deshpande S, Speak K. Hydrogel dressings for healing diabetic foot ulcers. Cochrane Database Syst Rev. 2013;7:CD009101. doi:10.1002/14651858.CD009101.pub3.

    PubMed  Google Scholar 

  63. Zhong SP, Zhang YZ, Lim CT. Tissue scaffolds for skin wound healing and dermal reconstruction. WIREs Nanomed Nanobiotechnol. 2010;2:510–25.

    Article  CAS  Google Scholar 

  64. Brigido SA, Boc SF, Lopez RC. Effective management of major lower extremity wounds using an acellular regenerative tissue matrix: a pilot study. Orthopedics. 2004;27 Suppl 1:s145–9.

    PubMed  Google Scholar 

  65. Brigido SA. The use of an acellular dermal regenerative tissue matrix in the treatment of lower extremity wounds: a prospective 16-week pilot study. Int Wound J. 2006;3:181–7.

    Article  PubMed  Google Scholar 

  66. Niezgoda JA, Van Gils CC, Frykberg RG, Hodde JP. Randomised clinical trial comparing OASIS Wound Matrix to Regranex Gel for diabetic ulcers. Adv Skin Wound Care. 2005;18(5):258–66.

    Article  PubMed  Google Scholar 

  67. Reyzelman A, Crews RT, Moore JC, et al. Clinical effectiveness of an acellular dermal regenerative tissue matrix compared to standard wound management in healing diabetic foot ulcers: a prospective, randomised, multicentre study. Int Wound J. 2009;6:196–208.

    Article  PubMed  Google Scholar 

  68. Gentzkpw GD, Iwasaki SD, Hershon KS, et al. Use of dermagraft, a cultured human dermis, to treat diabetic foot ulcers. Diabetes Care. 1996;19(4):350–4.

    Article  Google Scholar 

  69. Hanft JR, Surprenant MS. Healing of chronic foot ulcers in diabetic patients treated with a human fibroblast-derived dermis. J Foot Ankle Surg. 2002;41(5):291–9.

    Article  PubMed  Google Scholar 

  70. Marston WA, Hanft J, Norwood P, Pollak R, Dermagraft Diabetic Foot Ulcer Group. The efficacy and safety of Dermagraft in improving the healing of chronic diabetic foot ulcers: results of a prospective randomized trial. Diabetes Care. 2003;26(6):1701–5.

    Article  PubMed  Google Scholar 

  71. Veves A, Falanga V, Armstrong DG, Sabolinski ML, Apligraf Diabetic Foot Ulcer Study. Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers: a prospective randomized multicentre clinical trial. Diabetes Care. 2001;24(2):290–5.

    Article  CAS  PubMed  Google Scholar 

  72. Lev-Tov H, Li CS, Dahle S, Isserof RR. Cellular versus acellular matrix devices in treatment of diabetic foot ulcers: study protocol for a comparative efficacy randomized controlled trial. Trials. 2013;14:8. doi:10.1186/1745-6215-14-8.

    Article  PubMed Central  PubMed  Google Scholar 

  73. Armstrong DG, Jude EB. The role of matrix metalloproteinases in wound healing. J Am Podiatr Med Assoc. 2002;92:12–8.

    Article  PubMed  Google Scholar 

  74. Gibson D, Cullen B, Legerstee R, Harding KG, Schultz G. MMPs Made Easy. Wounds International 2009; 1(1): http://www.woundsinternational.com Accessed 04.02.2015

  75. Veves A, Sheehan P, Pham HT. A randomized, controlled trial of Promogran (a collagen/oxidized regenerated cellulose dressing) vs standard treatment in the management of diabetic foot ulcers. Arch Surg. 2002;137(7):822.7.

    Article  PubMed  Google Scholar 

  76. Barrientos S, Stojadinovic O, Golinko MS, et al. Growth factors and cytokines in wound healing. Wound Repair Regen. 2008;16:585–601.

    Article  PubMed  Google Scholar 

  77. Buchberger B, Follmann M, Freyer D, et al. The importance of growth factors for the treatment of chronic wounds in the case of diabetic foot ulcers. GMS Health Technol Assess 2010; 6: Doc12. doi: 10.3205/hta000090.

  78. Fu X, Li X, Cheng B, Chen W, Sheng Z. Engineered growth factors and cutaneous wound healing: success and possible questions in the past 10 years. Wound Repair Regen. 2005;13:122–30.

    Article  PubMed  Google Scholar 

  79. Mulder G, Tallis AJ, Marshall VT, et al. Treatment of nonhealing diabetic foot ulcers with a platelet-derived growth factor gene-activated matrix (GAM501): results of a phase 1/2 trial. Wound Repair Regen. 2009;17(6):772–9.

    Article  PubMed  Google Scholar 

  80. Blume P, Driver V, Tallis A, et al. Formulated collagen gel accelerates healing rate immediately after application in patients with diabetic neuropathic foot ulcers. Wound Repair Regen. 2011;19(3):302–8.

    Article  PubMed Central  PubMed  Google Scholar 

  81. Landsman A, Agnew P, Parish L, et al. Diabetic foot ulcers treated with becaplermin and TheraGauze, a moisture-controlling smart dressing: a randomized, multicenter, prospective analysis. J Am Podiatr Med Assoc. 2010;100(3):155–60.

    Article  PubMed  Google Scholar 

  82. Wieman TJ, Smiell JM, Su Y. Efficacy and safety of a topical gel formulation of recombinant human platelet-derived growth factor-BB (becaplermin) in patients with chronic neuropathic diabetic ulcers. A phase III randomized placebo-controlled double-blind study. Diabetes Care. 1998;21(5):822–7.

    Article  CAS  PubMed  Google Scholar 

  83. Fernández-Montequín JI, Valenzuela-Silva CM, Díaz OG, Cuban Diabetic Foot Study Group, et al. Intra-lesional injections of recombinant human epidermal growth factor promote granulation and healing in advanced diabetic foot ulcers: multicenter, randomised, placebo-controlled, double-blind study. Int Wound J. 2009;6(6):432–43.

    Article  PubMed  Google Scholar 

  84. Viswanathan V, Pendsey S, Sekar N, Murthy GSR. A phase III study to evaluate the safety and efficacy of recombinant human epidermal growth factor (REGEN-DTM 150) in healing diabetic foot ulcers. Wounds. 2006;18:186–96.

    Google Scholar 

  85. Tsang MW, Wong WK, Hung CS, et al. Human epidermal growth factor enhances healing of diabetic foot ulcers. Diabetes Care. 2003;26(6):1856–61.

    Article  CAS  PubMed  Google Scholar 

  86. Uchi H, Igarashi A, Urabe K, et al. Clinical efficacy of basic fibroblast growth factor (bFGF) for diabetic ulcer. Eur J Dermatol. 2009;19(5):461–8.

    PubMed  Google Scholar 

  87. Gough A, Clapperton M, Rolando N, et al. Randomised placebo-controlled trial of granulocyte-colony stimulating factor in diabetic foot infection. Lancet. 1997;350(9081):855–9.

    Article  CAS  PubMed  Google Scholar 

  88. Blumberg SN, Berger A, Hwang L, et al. The role of stem cells in the treatment of diabetic foot ulcers. Diabetes Res Clin Pract. 2012;96(1):1–9.

    Article  PubMed  Google Scholar 

  89. Lu D, Chen B, Liang Z. Comparison of bone marrow mesenchymal stem cells with bone marrow-derived mononuclear cells for treatment of diabetic critical limb ischemia and foot ulcer: a double-blind, randomized, controlled trial. Diabetes Res Clin Pract. 2011;92(1):26–36.

    Article  PubMed  Google Scholar 

  90. Yotsu RR, Hagiwara S, Okochi H, Tamaki T. Case series of patients with chronic foot ulcers treated with autologous platelet-rich plasma. J Dermatol. 2015. doi:10.1111/1346-8138.12777 [Epub ahead of print].

    PubMed  Google Scholar 

  91. Prompers L, Schaper N, Apelqvist J, et al. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study. Diabetologia. 2008;51(5):747–55.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  92. Lavery LA, Armstrong DA, Wunderlich RP, et al. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006;29(6):1288–93.

    Article  PubMed  Google Scholar 

  93. Lipsky BA, Berendt AR, Cornia PB. Infectious Disease Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. IDSA guidelines. Clin Infect Dis. 2012;54(12):132–73. This document provides useful guidance on the diagnosis and treatment of diabetic foot infection.

    Article  Google Scholar 

  94. Edmonds M, Foster AVM, Vowden P. Wound bed preparation for diabetic foot ulcers. In: EWMA Position Document. Wound bed preparation in practice. London: MEP Ltd, 2004. http://www.woundsinternational.com accessed 29.01.15

  95. Lipsky BA, Peters EJ, Senneville E, et al. Expert opinion on the management of infections in the diabetic foot. Diabetes Metab Res Rev. 2012;28:163–78.

    Article  PubMed  Google Scholar 

  96. Nelson EA, O’Meara S, Golder S, et al. Systematic review of antimicrobial treatments for diabetic foot ulcers. Diabet Med. 2006;23:348–59.

    Article  CAS  PubMed  Google Scholar 

  97. Vardakas KZ, Horianopoulou M, Falagas ME. Factors associated with treatment failure in patients with diabetic foot infections: an analysis of data from randomised controlled trials. Diabetes Res Clin Pract. 2008;80:344–51.

    Article  CAS  PubMed  Google Scholar 

  98. Crouzet J, Lavinge JP, Richard JL, et al. Diabetic foot infection : a critical review of recent randomised clinical trials on antibiotic therapy. Int J Infect Dis. 2011;15:e601–10.

    Article  CAS  PubMed  Google Scholar 

  99. Peters EJ, Lipsky BA, Berendt AR, et al. A systematic review of the effectiveness of interventions in the management of the infection in the diabetic foot. Diabetes Metab Res Rev. 2012;28:142–62.

    Article  PubMed  Google Scholar 

  100. Boykin Jr JV. Wound nitric oxide bioactivity: a promising diagnostic indicator for diabetic foot ulcer management. J Wound Ostomy Continence Nurs. 2010;37(1):25–32.

    Article  PubMed  Google Scholar 

  101. Mikaili P, Moloudizargari M, Aghajanshakeri S. Treatment with topical nitroglycerine may promote the healing process of diabetic foot ulcers. Med Hypotheses. 2014;83(2):172–4.

    Article  CAS  PubMed  Google Scholar 

  102. Aso Y, Tavama K, Takanashi K, et al. Changes in skin blood flow in type 2 diabetes induced by prostacyclin: association with ankle brachial index and plasma thrombomodulin levels. Metabolism. 2001;50(5):568–72.

    Article  CAS  PubMed  Google Scholar 

  103. Mirenda F, LaSpada M, Baccellieri D, et al. Iloprost infusion in diabetic patients with peripheral arterial occlusive disease and foot ulcers. Chir Ital. 2005;57(6):731–5.

    PubMed  Google Scholar 

  104. Young MJ, McCardle JE, Randall LE, Barclay JI. Improved survival of diabetic foot ulcer patients 1995–2008: possible impact of aggressive cardiovascular risk management. Diabetes Care. 2008;31(11):2143–7.

    Article  PubMed Central  PubMed  Google Scholar 

  105. Gulcan E, Gulcan A, Erbilen E, Toker S. Statins may be useful in diabetic foot ulceration treatment and prevention. Med Hypotheses. 2007;69(6):1313–5.

    Article  CAS  PubMed  Google Scholar 

  106. Johansen OE, Birkeland KI, Jørgensen AP, et al. Diabetic foot ulcer burden may be modified by high-dose atorvastatin: a 6-month randomized controlled pilot trial. J Diabetes. 2009;1(3):182–7.

    Article  CAS  PubMed  Google Scholar 

  107. Toker S, Gulcan E, Cayc MK, et al. Topical atorvastatin in the treatment of diabetic wounds. Am J Med Sci. 2009;338(3):201–4.

    Article  PubMed  Google Scholar 

  108. Marston WA, Group DDFUS. Risk factors associated with healing chronic diabetic foot ulcers: the importance of hyperglycaemia. Ostomy Wound Manage. 2006;52(3):26–8.

    PubMed  Google Scholar 

  109. American Diabetes Association. Consensus development conference on diabetic foot wound care. Diabetes Care. 1999;22:1345–60.

    Google Scholar 

  110. National Institute for Health and Care Excellence. NHS Evidence. Type 2 Diabetes: The management of type 2 diabetes May 2009. http://www.evidence.nhs.uk Accessed 29.01.15

  111. Sue Kirkman M, Briscoe VJ, Clark N, et al. Consensus Development Conference on Diabetes and older adults. Diabetes in older adults: a consensus report. J Am Geriatr Soc. 2012;60(12):2342–56.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Many thanks to Nia Jones, podiatrist, for kindly supplying the images.

Compliance with Ethics Guidelines

Conflict of Interest

Rhiannon L. Harries and Keith G. Harding declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Keith G. Harding.

Additional information

This article is part of the Topical Collection on Dermatology and Wound Care

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Harries, R.L., Harding, K.G. Management of Diabetic Foot Ulcers. Curr Geri Rep 4, 265–276 (2015). https://doi.org/10.1007/s13670-015-0133-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13670-015-0133-x

Keywords

Navigation