Chapter 22 - Management of the diabetic arteriopathy and diabetic foot
Abstract
Foot ulcers are common complications in patients with diabetes. People with diabetes are 20 times more susceptible to lower extremity amputation than people without diabetes as a result of foot complications. Effective management of foot complications in a diabetic patient requires a multidisciplinary approach involving diabetologists, vascular surgeons, podiatrists, nurses with expertise in advanced wound management, general surgeons, orthopedic specialists, and infectious disease specialists. The aim of a multidisciplinary diabetic foot program is to reduce the number of major amputations. The rate of lower extremity amputations and its trends over the years have been considered the marker of the quality of foot care in diabetes. Several changes in the daily practices are necessary to obtain reduced lower extremity amputations in diabetic patients. Armstrong et al. demonstrated that establishing an integrated multidisciplinary diabetic foot program impacts surgery type and changes the surgical volumes.
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Investigation and management of diabetic foot osteomyelitis: An update for the foot and ankle orthopaedic surgeon
2024, Journal of Clinical Orthopaedics and TraumaDiabetic foot osteomyelitis (DFO) poses a significant challenge in the management of diabetic patients, often leading to severe complications and increased morbidity.
Effective management of DFO requires a multidisciplinary approach, involving endocrinologists, infectious disease specialists, vascular surgeons, orthopaedic surgeons, and wound care experts. Early diagnosis is paramount, facilitated by advanced imaging techniques such as magnetic resonance imaging (MRI) and bone scintigraphy. Once diagnosed, the treatment strategy hinges on a combination of medical and surgical interventions.
Antibiotic therapy, guided by culture results, plays a central role in managing DFO. Tailored regimens targeting the specific pathogens involved are administered, often for prolonged durations. Surgical intervention becomes necessary when conservative measures fall short. Surgical approaches range from minimally invasive procedures, like percutaneous drainage, to more extensive interventions like debridement and bone resection.
Prevention of DFO recurrence is equally vital, emphasising glycemic control, meticulous foot care, patient education, monitoring of at-risk signs, revascularization and early intervention when indicated.
The management of diabetic foot osteomyelitis mandates a comprehensive strategy that addresses both the infectious and surgical aspects of the condition. A collaborative, interdisciplinary approach ensures timely diagnosis, tailored treatment, and holistic care. Further research into novel therapeutic modalities and long-term outcomes remains essential in refining the management of this complex and debilitating complication of diabetes.
Emergent management of diabetic foot problems in the modern era: Improving outcomes
2023, Seminars in Vascular SurgeryLimb amputation is a consequence, and the leading complication, of diabetic foot ulcers. Prevention depends on prompt diagnosis and management. Patients should be managed by multidisciplinary teams and efforts should be focused on limb salvage (“time is tissue”). The diabetic foot service should be organized in a way to meet the patient's clinical needs, with the diabetic foot centers at the highest level of this structure. Surgical management should be multimodal and include not only revascularization, but also surgical and biological debridement, minor amputations, and advanced wound therapy. Medical treatment, including an adequate antimicrobial therapy, has a key role in the eradication of infection and should be guided by microbiologists and infection disease physicians with special interest in bone infection. Input from diabetologists, radiologists, orthopedic teams (foot and ankle), orthotists, podiatrists, physiotherapists, and prosthetics, as well as psychological counseling, is required to make the service comprehensive. After the acute phase, a well-structured, pragmatic follow-up program is necessary to adequately manage the patients with the aim to detect earlier potential failures of the revascularization or antimicrobial therapy. Considering the cost and societal impact of diabetic foot problems, health care providers should provide resources to manage the burden of diabetic foot problems in the modern era.