Prevention and management of foot problems in diabetes: a Summary Guidance for Daily Practice 2015, based on the IWGDF Guidance Documents.
In this 'Summary Guidance for Daily Practice', we describe the basic principles of prevention and management of foot problems in persons with diabetes. This summary is based on the International Working Group on the Diabetic Foot (IWGDF) Guidance 2015. There are five key elements that underpin prevention of foot problems: (1) identification of the at-risk foot; (2) regular inspection and examination of the at-risk foot; (3) education of patient, family and healthcare providers; (4) routine wearing of appropriate footwear; and (5) treatment of pre-ulcerative signs. Healthcare providers should follow a standardized and consistent strategy for evaluating a foot wound, as this will guide further evaluation and therapy. The following items must be addressed: type, cause, site and depth, and signs of infection. There are seven key elements that underpin ulcer treatment: (1) relief of pressure and protection of the ulcer; (2) restoration of skin perfusion; (3) treatment of infection; (4) metabolic control and treatment of co-morbidity; (5) local wound care; (6) education for patient and relatives; and (7) prevention of recurrence. Finally, successful efforts to prevent and manage foot problems in diabetes depend upon a well-organized team, using a holistic approach in which the ulcer is seen as a sign of multi-organ disease, and integrating the various disciplines involved.
Div. Endocrinology, MUMC+, CARIM and CAPHRI Institutes, Maastricht, The Netherlands.
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NC
Schaper
Department of Surgery, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands.
J J
JJ
Van Netten
Department of Endocrinology, University Hospital of Malmö, Malmö, Sweden.
J
J
Apelqvist
Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland, and University of Oxford, Oxford, UK.
B A
BA
Lipsky
IWGDF, Heemstede, The Netherlands.
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K
Bakker
D003131:Combined Modality Therapy / Q000639:trends; D003925:Diabetic Angiopathies / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D017719:Diabetic Foot / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D003929:Diabetic Neuropathies / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D042241:Early Diagnosis; D019317:Evidence-Based Medicine; D014943:Global Health; D006694:Holistic Health; D006801:Humans; D007390:International Agencies; D010348:Patient Care Team / Q000639:trends; D010353:Patient Education as Topic; D057285:Precision Medicine; D012008:Recurrence; D012720:Severity of Illness Index; D012775:Shoes / Q000009:adverse effects; D018461:Soft Tissue Infections / Q000150:complications / Q000517:prevention & control
IWGDF; daily practice; diabetic foot; foot ulcer; guidance; guidelines; implementation