title: Wound management of chronic diabetic foot ulcers: from the basics to regenerative medicine.
abstract: BACKGROUND
  Hospital-based studies have shown that mortality rates in individuals with diabetic foot ulcers are about twice those observed in individuals with diabetes without foot ulcers.
  
  
  OBJECTIVE
  To assess the etiology and management of chronic diabetic foot ulcers.
  
  
  METHODS
  Literature review.
  
  
  METHODS
  Systematic review of the literature discussing management of diabetic foot ulcers. Since there were only a few randomized controlled trials on this topic, articles were selected to attempt to be comprehensive rather than a formal assessment of study quality.
  
  
  RESULTS
  Chronic nonhealing foot ulcers occur in approximately 15% of patients with diabetes. Many factors contribute to impaired diabetic wound healing. Risk factors include peripheral neuropathy, peripheral arterial disease, limited joint mobility, foot deformities, abnormal foot pressures, minor trauma, a history of ulceration or amputation, and impaired visual acuity. With the current treatment for nonhealing diabetic foot ulcers, a significant number of patients require amputation.
  
  
  CONCLUSIONS
  Diabetic foot ulcers are optimally managed by a multidisciplinary integrated team. Offloading and preventative management are important. Dressings play an adjunctive role. There is a critical need to develop novel treatments to improve healing of diabetic foot ulcers. The goal is to have wounds heal and remain healed.
  
  
  CONCLUSIONS
  Diabetic neuropathy and peripheral arterial disease are major factors involved in a diabetic foot ulcer. Despite current treatment modalities for nonhealing diabetic foot ulcers, there are a significant number of patients who require amputations. No known therapy will be effective without concomitant management of ischemia, infection, and adequate offloading.
authors.affiliation: Vascular Ulcer/Wound Healing Clinic, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA andrews.karen@mayo.edu.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Andrews
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Houdek
authors.affiliation: Vascular Ulcer/Wound Healing Clinic, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.
authors.forename: Lester J
authors.initials: LJ
authors.lastname: Kiemele
mesh_terms: D000671:Amputation, Surgical; D002908:Chronic Disease; D017719:Diabetic Foot / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D010348:Patient Care Team; D044968:Regenerative Medicine / Q000639:trends*; D012307:Risk Factors; D014945:Wound Healing / Q000502:physiology*
keywords: Diabetes; diabetic foot ulcer; neuropathy; wounds