Table of contents
Expand All Topics
Diabetic foot
Background
Overview
Definition
Diabetic foot is a complication of diabetes characterized by a triad of neuropathy, ischemia, and infection.
1
Pathophysiology
Diabetic foot is caused due to uncontrolled diabetes leading to the development of peripheral neuropathy (loss of sensation) and PAD (ischemia).
1
Disease course
Clinical manifestations due to peripheral neuropathy lead to fissures, bullae, Charcot joint, edema, digital necrosis; and ischemia lead to pain at rest, ulceration on foot margins, digital necrosis, and gangrene. Disease progression may lead to osteomyelitis (chronic discharging sinus and sausage-like appearance of the toe) and gangrene formation that may require amputation.
1
Prognosis and risk of recurrence
The all-cause mortality related to diabetic foot ulcer and lower extremity amputation is 42.54 per 1,000 person-years and 86.80 per 1,000 person-years.
2
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of diabetic foot are prepared by our editorial team based on guidelines from the American Diabetes Association (ADA 2025) and the Society for Vascular Medicine (SVM/SVS/APMA 2016).
1
2
3
4
Screening and diagnosis
Indications for screening, average-risk patients: as per ADA 2025 guidelines, obtain a comprehensive foot evaluation at least annually to identify risk factors for ulcers and amputations.
A
More topics in this section
Indications for screening (high-risk patients)
Indications for screening (pediatric patients)
Diagnostic investigations
Medical history: as per ADA 2025 guidelines, elicit a history of ulceration, amputation, Charcot foot, angioplasty or vascular surgery, cigarette smoking, retinopathy, and renal disease and assess current symptoms of neuropathy (pain, burning, numbness) and vascular disease (leg fatigue, claudication).
B
More topics in this section
Physical examination
Ankle-brachial index
Medical management
Interprofessional care: as per ADA 2025 guidelines, ensure an interprofessional approach facilitated by a podiatrist in conjunction with other appropriate team members in patients with foot ulcers and high-risk feet (such as patients on dialysis, with Charcot foot, history of ulcers or amputation, or PAD).
B
More topics in this section
Glycemic control
Nonpharmacologic interventions
Therapeutic procedures
Revascularization
As per APMA/SVM/SVS 2016 guidelines:
Do not perform prophylactic arterial revascularization to prevent diabetic foot ulcer.
D
Perform revascularization by either surgical bypass or endovascular therapy in patients with diabetic foot ulcer and PAD.
B
More topics in this section
Other therapies
Surgical interventions
Wound care
As per APMA/SVM/SVS 2016 guidelines:
Obtain frequent evaluation at 1-4-week intervals with measurement of diabetic foot ulcers to monitor reduction of wound size and healing progress.
B
Use dressing products maintaining a moist wound bed, controlling exudate, and avoiding maceration of surrounding intact skin in patients with diabetic foot ulcers.
B
More topics in this section
Surgical debridement
Patient education
Foot self-care education: as per ADA 2025 guidelines, provide general preventive foot self-care education to all patients with diabetes, including patients with loss of protective sensation, on appropriate ways to examine their feet (palpation or visual inspection with an unbreakable mirror) for daily surveillance of early foot problems.
B
Follow-up and surveillance
Indications for specialist referral: as per ADA 2025 guidelines, refer smoker patients or patients with a history of prior lower extremity complications, loss of protective sensation, structural abnormality, or PAD to foot care specialists for ongoing preventive care and life-long surveillance.
B
provide these patients with information on the importance of smoking cessation and refer for counseling on smoking cessation. A