Skip to main content

The Diabetic Foot

  • Chapter
  • First Online:
Evidence-based Therapy in Vascular Surgery

Abstract

Patients with diabetic foot and peripheral arterial disease (PAD) may be treated with either endovascular intervention or open revascularization; there are no evidence-based recommendations showing that one method is more advantageous than the other. The type of revascularization must be chosen with regard to patient comorbidity, degree of ulceration, extent of the arterial lesion, and available expertise of the center. Diabetic foot osteomyelitis can be treated using either primarily surgical or primarily medical strategies.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Baltodano PA, Basdag B, Bailey CR, et al. The positive effect of neurolysis on diabetic patients with compressed nerves of the lower extremities: a systematic review and meta-analysis. Plast Reconstr Surg Glob Open. 2013;1:e24.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bhamidipaty V, Dean A, Yap SL, Firth J, Barron M, Allard B, Chan ST. Second toe systolic pressure measurements are valid substitutes for first toe systolic pressure measurements in diabetic patients: a prospective study. Eur J Vasc Endovasc Surg. 2015;49:77–82.

    Article  CAS  PubMed  Google Scholar 

  • Brownrigg JR, Griffin M, Hughes CO, Jones KG, Patel N, Thompson MM, Hinchliffe RJ. Influence of foot ulceration on cause-specific mortality in patients with diabetes mellitus. J Vasc Surg. 2014;60:982–6.

    Article  PubMed  Google Scholar 

  • Brownrigg JR, Hinchliffe RJ, Apelqvist J, et al.; International Working Group on the Diabetic Foot. Performance of prognostic markers in the prediction of wound healing or amputation among patients with foot ulcers in diabetes: a systematic review. Diabetes Metab Res Rev. 2016;32(Suppl 1):128–35.

    Google Scholar 

  • Causey MW, Ahmed A, Wu B, Gasper WJ, Reyzelman A, Vartanian SM, Hiramoto JS, Conte MS. Society for Vascular Surgery limb stage and patient risk correlate with outcomes in an amputation prevention program. J Vasc Surg. 2016;63:1563–73.

    Article  PubMed  Google Scholar 

  • Cull DL, Manos G, Hartley MC, Taylor SM, Langan EM, Eidt JF, Johnson BL. An early validation of the Society for Vascular Surgery lower extremity threatened limb classification system. J Vasc Surg. 2014;60:1535–42.

    Article  PubMed  Google Scholar 

  • Dallimore SM, Kaminski MR. Tendon lengthening and fascia release for healing and preventing diabetic foot ulcers: a systematic review and meta-analysis. J Foot Ankle Res. 2015;8:33.

    Article  PubMed  PubMed Central  Google Scholar 

  • DubskĂ˝ M, Jirkovská A, Bem R, Fejfarová V, Skibová J, Schaper NC, Lipsky BA. Risk factors for recurrence of diabetic foot ulcers: prospective follow-up analysis in the Eurodiale subgroup. Int Wound J. 2013;10:555–61.

    Article  PubMed  Google Scholar 

  • Duhon BM, Hand EO, Howell CK, Reveles KR. Retrospective cohort study evaluating the incidence of diabetic foot infections among hospitalized adults with diabetes in the United States from 1996–2010. Am J Infect Control. 2016;44:199–202.

    Article  PubMed  Google Scholar 

  • Dumville JC, Deshpande S, O’Meara S, Speak K. Hydrocolloid dressings for healing diabetic foot ulcers. Cochrane Database Syst Rev. 2013a;(8):CD009099.

    Google Scholar 

  • Dumville JC, O’Meara S, Deshpande S, Speak K. Alginate dressings for healing diabetic foot ulcers. Cochrane Database Syst Rev. 2013b;(6):CD009110.

    Google Scholar 

  • Dumville JC, Deshpande S, O’Meara S, Speak K. Foam dressings for healing diabetic foot ulcers. Cochrane Database Syst Rev. 2013c;(6):CD009111.

    Google Scholar 

  • Dumville JC, Hinchliffe RJ, Cullum N, Game F, Stubbs N, Sweeting M, Peinemann F. Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus. Cochrane Database Syst Rev. 2013d;(10):CD010318.

    Google Scholar 

  • Elraiyah T, Domecq JP, Prutsky G, et al. A systematic review and meta-analysis of dĂ©bridement methods for chronic diabetic foot ulcers. J Vasc Surg. 2016a;63(2 Suppl):37S–45S.

    Article  PubMed  Google Scholar 

  • Elraiyah T, Tsapas A, Prutsky G, et al. A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers. J Vasc Surg. 2016b;63(2 Suppl):46S–58S.

    Article  PubMed  Google Scholar 

  • Elraiyah T, Prutsky G, Domecq JP, et al. A systematic review and meta-analysis of off-loading methods for diabetic foot ulcers. J Vasc Surg. 2016c;63(2 Suppl):59S–68S.

    Article  PubMed  Google Scholar 

  • Fedorko L, Bowen JM, Jones W, Oreopoulos G, Goeree R, Hopkins RB, O’Reilly DJ. Hyperbaric oygen therapy does not reduce indications for amputation in patients with diabetes with nonhealing ulcers of the lower limb: a prospective, double-blind, randomized controlled clinical trial. Diabetes Care. 2016;39:392–9.

    Article  CAS  PubMed  Google Scholar 

  • Fossaceca R, Guzzardi G, Cerini P, et al. Endovascular treatment of diabetic foot in a selected population of patients with below-the-knee disease: is the angiosome model effective? Cardiovasc Intervent Radiol. 2013;36:637–44.

    Article  PubMed  Google Scholar 

  • Game FL, Apelqvist J, Attinger C, Hartemann A, Hinchliffe RJ, Löndahl M, Price PE, Jeffcoate WJ, International Working Group on the Diabetic Foot. Effectiveness of interventions to enhance healing of chronic ulcers of the foot in diabetes: a systematic review. Diabetes Metab Res Rev. 2016;32(Suppl 1):154–68.

    Article  PubMed  Google Scholar 

  • Hinchliffe RJ, Brownrigg JR, Andros G, et al.; International Working Group on the Diabetic Foot. Effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral artery disease: a systematic review. Diabetes Metab Res Rev. 2016;32(Suppl 1):136–44.

    Google Scholar 

  • Hingorani A, LaMuraglia GM, Henke P, Meissner MH, Loretz L, Zinszer KM, Driver VR, Frykberg R, Carman TL, Marston W, Mills Sr JL, Murad MH. The management of diabetic foot: a clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. J Vasc Surg. 2016;63(2 Suppl):3S–21S.

    Article  PubMed  Google Scholar 

  • Lavery LA, Davis KE, Berriman SJ, Braun L, Nichols A, Kim PJ, Margolis D, Peters EJ, Attinger C. WHS guidelines update: diabetic foot ulcer treatment guidelines. Wound Repair Regen. 2016;24:112–26.

    Article  PubMed  Google Scholar 

  • Lipsky BA, AragĂłn-Sánchez J, Diggle M, Embil J, Kono S, Lavery L, Senneville É, UrbanÄŤiÄŤ-Rovan V, Van Asten S, International Working Group on the Diabetic Foot. IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes. Diabetes Metab Res Rev. 2016;32(Suppl 1):45–74.

    Article  PubMed  Google Scholar 

  • Lombardo FL, Maggini M, De Bellis A, Seghieri G, Anichini R. Lower extremity amputations in persons with and without diabetes in Italy: 2001–2010. PLoS One. 2014;9:e86405.

    Article  PubMed  PubMed Central  Google Scholar 

  • MacarĂ© van Maurik JF, van Hal M, van Eijk RP, Kon M, Peters EJ. Value of surgical decompression of compressed nerves in the lower extremity in patients with painful diabetic neuropathy: a randomized controlled trial. Plast Reconstr Surg. 2014;134:325–32.

    Article  PubMed  Google Scholar 

  • MacarĂ© van Maurik JF, Ter Horst B, van Hal M, Kon M, Peters EJ. Effect of surgical decompression of nerves in the lower extremity in patients with painful diabetic polyneuropathy on stability: a randomized controlled trial. Clin Rehabil. 2015a;29:994–1001.

    Article  PubMed  Google Scholar 

  • MacarĂ© van Maurik JF, Oomen RT, van Hal M, Kon M, Peters EJ. The effect of lower extremity nerve decompression on health-related quality of life and perception of pain in patients with painful diabetic polyneuropathy: a prospective randomized trial. Diabet Med. 2015b;32:803–9.

    Article  PubMed  Google Scholar 

  • Malyar NM, Freisinger E, Meyborg M, LĂĽders F, Gebauer K, Reinecke H, Lawall H. Amputations and mortality in in-hospital treated patients with peripheral artery disease and diabetic foot syndrome. J Diabetes Complications. 2016;30:1117–22.

    Google Scholar 

  • Martins-Mendes D, Monteiro-Soares M, Boyko EJ, Ribeiro M, Barata P, Lima J, Soares R. The independent contribution of diabetic foot ulcer on lower extremity amputation and mortality risk. J Diabetes Complications. 2014;28:632–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mills JL, Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, Andros G, Society for Vascular Surgery Lower Extremity Guidelines Committee. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg. 2014;59:220–34.

    Article  PubMed  Google Scholar 

  • Morbach S, Furchert H, Gröblinghoff U, et al. Long-term prognosis of diabetic foot patients and their limbs: amputation and death over the course of a decade. Diabetes Care. 2012;35:2021–7.

    Article  PubMed  PubMed Central  Google Scholar 

  • National Institute for Health and Care Excellence (NICE). Diabetic foot problems: prevention and management. NICE guideline published: 26 August 2015. 2015. www.nice.org.uk/guidance/ng19/resources/diabetic-foot-problems-prevention-and-management-1837279828933.

  • Nickerson DS, Rader AJ. Nerve decompression after diabetic foot ulceration may protect against recurrence: a 3-year controlled, prospective analysis. J Am Podiatr Med Assoc. 2014;104:66–70.

    Article  PubMed  Google Scholar 

  • Pickwell KM, Siersma VD, Kars M, Holstein PE, Schaper NC, Eurodiale consortium. Diabetic foot disease: impact of ulcer location on ulcer healing. Diabetes Metab Res Rev. 2013;29:377–83.

    Article  PubMed  Google Scholar 

  • Santema TK, Poyck PP, Ubbink DT. Systematic review and meta-analysis of skin substitutes in the treatment of diabetic foot ulcers: highlights of a Cochrane systematic review. Wound Repair Regen. 2016;24:737–44.

    Google Scholar 

  • Schanzer A, Goodney PP, Li Y, Eslami M, Cronenwett J, Messina L, Conte MS; Vascular Study Group of Northern New England. Validation of the PIII CLI risk score for the prediction of amputation-free survival in patients undergoing infrainguinal autogenous vein bypass for critical limb ischemia. J Vasc Surg. 2009;50:769–75; discussion 775.

    Google Scholar 

  • Selva Olid A, SolĂ  I, Barajas-Nava LA, Gianneo OD, Bonfill Cosp X, Lipsky BA. Systemic antibiotics for treating diabetic foot infections. Cochrane Database Syst Rev. 2015;(9):CD009061.

    Google Scholar 

  • Skrepnek GH, Armstrong DG, Mills JL. Open bypass and endovascular procedures among diabetic foot ulcer cases in the United States from 2001 to 2010. J Vasc Surg. 2014;60:1255–65.

    Article  PubMed  Google Scholar 

  • Söderström M, Albäck A, Biancari F, Lappalainen K, Lepäntalo M, Venermo M. Angiosome-targeted infrapopliteal endovascular revascularization for treatment of diabetic foot ulcers. J Vasc Surg. 2013;57:427–35.

    Article  PubMed  Google Scholar 

  • Stoekenbroek RM, Santema TB, Legemate DA, Ubbink DT, van den Brink A, Koelemay MJ. Hyperbaric oxygen for the treatment of diabetic foot ulcers: a systematic review. Eur J Vasc Endovasc Surg. 2014;47:647–55.

    Article  CAS  PubMed  Google Scholar 

  • Tone A, Nguyen S, Devemy F, et al. Six- versus twelve-week antibiotic therapy for nonsurgically treated diabetic foot osteomyelitis: a multicenter open-label controlled randomized study. Diabetes Care. 2015;38:302–7.

    Article  PubMed  Google Scholar 

  • Zhan LX, Branco BC, Armstrong DG, Mills JL. The Society for Vascular Surgery lower extremity threatened limb classification system based on Wound, Ischemia, and foot Infection (WIfI) correlates with risk of major amputation and time to wound healing. J Vasc Surg. 2015;61:939–44.

    Article  PubMed  Google Scholar 

  • Zhang J, Hu ZC, Chen D, Guo D, Zhu JY, Tang B. Effectiveness and safety of negative-pressure wound therapy for diabetic foot ulcers: a meta-analysis. Plast Reconstr Surg. 2014;134:141–51.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Debus, E.S., Grundmann, R.T. (2017). The Diabetic Foot. In: Evidence-based Therapy in Vascular Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-47148-8_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-47148-8_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-47147-1

  • Online ISBN: 978-3-319-47148-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics