title: The diabetic foot: a review.
abstract: Diabetic foot ulceration (DFU) is among the most frequent complications of diabetes. Neuropathy and ischaemia are the initiating factors and infection is mostly a consequence. We have shown in this review that any DFU should be considered to have vascular impairment. DFU will generally heal if the toe pressure is >55 mmHg and a transcutaneous oxygen pressure (TcPO2) <30 mmHg has been considered to predict that a diabetic ulcer may not heal. The decision to intervene is complex and made according to the symptoms and clinical ﬁndings. If both an endovascular and a bypass procedure are possible with an equal outcome to be expected, endovascular treatments should be preferred. Primary and secondary mid-term patency rates are better after bypass, but there is no difference in limb salvage. Bedridden patients with poor life expectancy and a non-revascularisable leg are indications for performing a major amputation. A deep infection is the immediate cause of amputation in 25% to 50% of diabetic patients. Patients with uncontrolled abscess, bone or joint involvement, gangrene, or necrotising fasciitis have a "foot-at risk" and need prompt surgical intervention with debridement and revascularisation. As demonstrated in this review, foot ulcer in diabetic is associated with high mortality and morbidity. Early referral, non-invasive vascular testing, imaging and intervention are crucial to improve DFU healing and to prevent amputation. Diabetics are eight to twenty-four times more likely than non-diabetics to have a lower limb amputation and it has been suggested that a large part of those amputations could be avoided by an early diagnosis and a multidisciplinary approach.
authors.affiliation: Vascular Surgery Department, Jean Bernard Hospital University of Poitiers, Poitiers, France - jeanbaptistericco@gmail.com.
authors.forename: J B
authors.initials: JB
authors.lastname: Ricco
authors.forename: L
authors.initials: L
authors.lastname: Thanh Phong
authors.forename: F
authors.initials: F
authors.lastname: Schneider
authors.forename: G
authors.initials: G
authors.lastname: Illuminati
authors.forename: R
authors.initials: R
authors.lastname: Belmonte
authors.forename: A
authors.initials: A
authors.lastname: Valagier
authors.forename: G
authors.initials: G
authors.lastname: Régnault De La Mothe
mesh_terms: D000671:Amputation, Surgical / Q000379:methods*; D017719:Diabetic Foot / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D023821:Limb Salvage / Q000379:methods*; D014656:Vascular Surgical Procedures