title: Inpatient management of diabetic foot disorders: a clinical guide.
abstract: The implementation of an inpatient diabetic foot service should be the goal of all institutions that care for patients with diabetes. The objectives of this team are to prevent problems in patients while hospitalized, provide curative measures for patients admitted with diabetic foot disorders, and optimize the transition from inpatient to outpatient care. Essential skills that are required for an inpatient team include the ability to stage a foot wound, assess for peripheral vascular disease, neuropathy, wound infection, and the need for debridement; appropriately culture a wound and select antibiotic therapy; provide, directly or indirectly, for optimal metabolic control; and implement effective discharge planning to prevent a recurrence. Diabetic foot ulcers may be present in patients who are admitted for nonfoot problems, and these ulcers should be evaluated by the diabetic foot team during the hospitalization. Pathways should be in place for urgent or emergent treatment of diabetic foot infections and neuropathic fractures/dislocations. Surgeons involved with these patients should have knowledge and interest in limb preservation techniques. Prevention of iatrogenic foot complications, such as pressure sores of the heel, should be a priority in patients with diabetes who are admitted for any reason: all hospitalized diabetic patients require a clinical foot exam on admission to identify risk factors such as loss of sensation or ischemia. Appropriate posthospitalization monitoring to reduce the risk of reulceration and infection should be available, which should include optimal glycemic control and correction of any fluid and electrolyte disturbances.
authors: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. wukichdk@upmc.edu
authors: Dane K
authors: DK
authors: Wukich
authors: David G
authors: DG
authors: Armstrong
authors: Christopher E
authors: CE
authors: Attinger
authors: Andrew J M
authors: AJ
authors: Boulton
authors: Patrick R
authors: PR
authors: Burns
authors: Robert G
authors: RG
authors: Frykberg
authors: Richard
authors: R
authors: Hellman
authors: Paul J
authors: PJ
authors: Kim
authors: Benjamin A
authors: BA
authors: Lipsky
authors: James C
authors: JC
authors: Pile
authors: Michael S
authors: MS
authors: Pinzur
authors: Linda
authors: L
authors: Siminerio
mesh_terms: D017719:Diabetic Foot / Q000503:physiopathology* / Q000601:surgery*; D019468:Disease Management; D006801:Humans; D007297:Inpatients
references: Am J Med. 1996 Nov;101(5):521-5
references: 8948276
references: Cochrane Database Syst Rev. 2009 Jul 08;(3):CD006810
references: 19588405
references: J Vasc Surg. 2006 Aug;44(2):347-351; discussion 352
references: 16890866
references: J Bone Joint Surg Am. 2008 Jul;90(7):1570-8
references: 18594108
references: Lancet. 2005 Nov 12;366(9498):1704-10
references: 16291063
references: J Bone Joint Surg Am. 2005 Aug;87(8):1712-8
references: 16085609
references: Diabetes Care. 2008 Aug;31(8):1679-85
references: 18663232
references: Foot Ankle Int. 2006 Oct;27(10):797-800
references: 17054880
references: Diabetes Care. 2011 Sep;34(9):2123-9
references: 21868781
references: Clin Microbiol Infect. 2007 Apr;13(4):351-3
references: 17359317
references: J Infect. 2007 Oct;55(4):369-73
references: 17675245
references: Diabetes Care. 2004 Aug;27(8):1954-61
references: 15277423
references: Diabetes Care. 2006 Jun;29(6):1288-93
references: 16732010
references: Clin Infect Dis. 2012 Jun;54(12):e132-73
references: 22619242
references: Diabetes Care. 2008 Jan;31(1):99-101
references: 17934144
references: Diabetologia. 2009 Jul;52(7):1265-73
references: 19399473
references: Diabetes Care. 2009 Jun;32(6):1119-31
references: 19429873
references: Int J Low Extrem Wounds. 2011 Mar;10(1):33-65
references: 21444608
references: N Engl J Med. 2004 Dec 30;351(27):2795-804
references: 15625331
references: Wound Repair Regen. 2009 Jul-Aug;17(4):461-72
references: 19614910
references: Int Wound J. 2007 Dec;4(4):286-7
references: 18154621
references: Diabetes Care. 2008 Apr;31(4):631-6
references: 18162494
references: Rev Esp Quimioter. 2011 Dec;24(4):233-62
references: 22173195
references: J Hosp Med. 2008 Sep;3(5 Suppl):55-65
references: 18951384
references: Am J Surg. 2003 Nov 28;186(5A):44S-54S; discussion 61S-64S
references: 14684226
references: J Am Coll Cardiol. 2006 Sep 5;48(5):964-9
references: 16949487
references: J Am Podiatr Med Assoc. 2008 Jul-Aug;98(4):290-5
references: 18685049
references: Diabet Med. 2011 Feb;28(2):195-8
references: 21219429
references: Foot Ankle Int. 2011 Feb;32(2):120-30
references: 21288410
references: Eplasty. 2009;9:e15
references: 19436764
references: Int Wound J. 2007 Mar;4(1):30-8
references: 17425547
references: Diabetologia. 2007 Jan;50(1):18-25
references: 17093942
references: N Engl J Med. 1998 Jul 23;339(4):229-34
references: 9673301
references: Foot Ankle Int. 2003 Nov;24(11):838-44
references: 14655888
references: J Vasc Surg. 1988 Oct;8(4):428-33
references: 3172378
references: J Am Podiatr Med Assoc. 2010 Jul-Aug;100(4):309-11
references: 20660885
references: J Foot Ankle Surg. 1996 Jul-Aug;35(4):280-3
references: 8872749
references: Horm Metab Res. 2010 Oct;42(11):763-8
references: 20711953
references: Diabetes Metab Res Rev. 2012 Sep;28(6):514-8
references: 22431496
references: South Med J. 2006 Jun;99(6):580-9; quiz 590-1
references: 16800413
references: JAMA. 2009 Apr 15;301(15):1556-64
references: 19366775
references: Br J Surg. 1986 May;73(5):392-4
references: 3708295
references: Int J Infect Dis. 2011 Sep;15(9):e601-10
references: 21737333
references: J Am Podiatr Med Assoc. 1996 May;86(5):224-7
references: 8776158
references: Curr Diab Rep. 2008 Apr;8(2):119-25
references: 18445354
references: J Foot Ankle Surg. 2006 Sep-Oct;45(5 Suppl):S1-66
references: 17280936
references: Diabetes Care. 2001 Jan;24(1):84-8
references: 11194247
references: Diabetes Care. 2007 Dec;30(12):3058-62
references: 17898089
references: J Bone Joint Surg Br. 2005 Apr;87(4):489-95
references: 15795198
references: J Surg Orthop Adv. 2005 Summer;14(2):85-91
references: 16115434
references: Diabetes Metab Res Rev. 2008 May-Jun;24 Suppl 1:S145-61
references: 18442163
references: Endocrinol Metab Clin North Am. 2012 Mar;41(1):175-201
references: 22575413
references: Eur J Nucl Med Mol Imaging. 2005 Jan;32(1):60-9
references: 15309331
references: Diabet Med. 2004 Jul;21(7):705-9
references: 15209762
references: Circulation. 2007 Oct 23;116(17):e418-99
references: 17901357
references: Am J Cardiol. 2004 Apr 1;93(7):870-5
references: 15050491
references: Diabetes Care. 2005 Apr;28(4):956-62
references: 15793206
references: Diabetes Metab Res Rev. 2012 Feb;28 Suppl 1:119-41
references: 22271737
references: Diabetes Care. 1995 Jan;18(1):34-8
references: 7698045
references: Diabetologia. 2010 Oct;53(10):2241-8
references: 20556354
references: J Am Podiatr Med Assoc. 2010 Sep-Oct;100(5):401-5
references: 20847354
references: J Clin Endocrinol Metab. 2012 Jan;97(1):16-38
references: 22223765
references: Ann Intern Med. 2011 Feb 15;154(4):260-7
references: 21320941
references: Diabetes Care. 2010 May;33(5):1086-9
references: 20185744
references: J Clin Endocrinol Metab. 2012 Jan;97(1):49-58
references: 22090269
references: Diabetes Metab. 2011 Jun;37(3):208-15
references: 21169044
references: Diabetes Care. 1999 Sep;22(9):1428-31
references: 10480504
references: J Am Coll Cardiol. 2007 May 1;49(17):1763-9
references: 17466225
references: Diabetes Care. 2011 Feb;34(2):256-61
references: 21228246
references: Diabetes Care. 2010 May;33(5):1143-5
references: 20427686