Diabetic foot ulcers. Pathophysiology, assessment, and therapy.
OBJECTIVE
To review underlying causes of diabetic foot ulceration, provide a practical assessment of patients at risk, and outline an evidence-based approach to therapy for diabetic patients with foot ulcers.


METHODS
A MEDLINE search was conducted for the period from 1979 to 1999 for articles relating to diabetic foot ulcers. Most studies found were case series or small controlled trials.


RESULTS
Foot ulcers in diabetic patients are common and frequently lead to lower limb amputation unless a prompt, rational, multidisciplinary approach to therapy is taken. Factors that affect development and healing of diabetic patients' foot ulcers include the degree of metabolic control, the presence of ischemia or infection, and continuing trauma to feet from excessive plantar pressure or poorly fitting shoes. Appropriate wound care for diabetic patients addresses these issues and provides optimal local ulcer therapy with débridement of necrotic tissue and provision of a moist wound-healing environment. Therapies that have no known therapeutic value, such as foot soaking and topical antiseptics, can actually be harmful and should be avoided.


CONCLUSIONS
Family physicians are often primary medical contacts for patients with diabetes. Patients should be screened regularly for diabetic foot complications, and preventive measures should be initiated for those at risk of ulceration.
Bowering
C K
CK
Multidisciplinary Diabetic Foot Clinic, Royal Alexandra Hospital, Edmonton, Alta. kbowerin@ualberta.ca
D017719:Diabetic Foot / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D003952:Diagnostic Imaging; D006801:Humans; D009460:Neurologic Examination; D009983:Orthopedic Equipment; D010353:Patient Education as Topic; D012307:Risk Factors; D017592:Skin Care