One of the key areas of morbidity associated with diabetes is the diabetic foot. To improve the care of patients with diabetic foot and to provide an evidence-based multidisciplinary management approach, the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine developed a set of clinical practice guidelines (J Vasc Surg 2016;63:3S-21S.)
The guidelines include preventive recommendations such as those for adequate glycemic control, periodic foot inspection, and patient and family education; recommendations about using custom therapeutic footwear in high-risk diabetic patients, including those with significant neuropathy, foot deformities, or previous amputation. In patients with plantar diabetic foot ulcer (DFU), off-loading should be done with a total contact cast or irremovable fixed ankle walking boot. In patients with a new DFU, probe to bone test and plain films should be followed by magnetic resonance imaging if a soft tissue abscess or osteomyelitis is suspected. Recommendations on comprehensive wound care and various débridement methods have been presented. For DFUs that fail to improve (>50% wound area reduction) after a minimum of 4 weeks of standard wound therapy, adjunctive wound therapy options are presented. Patients with DFU who have peripheral arterial disease need revascularization by either surgical bypass or endovascular therapy.
Algorithm for prevention and care of diabetic foot.
Click here to download the guidelines.