Foot ulcers in the diabetic patient, prevention and treatment

Vascular Health and Risk Management

Volumn 3, Issue 1, 2007, Pages 65-76

  Wu, Stephanie C ^a,b   Driver, Vickie R ^a,b   Wrobel, James S ^a   Armstrong, David G ^a  

^a ROSALIND FRANKLIN UNIVERSITY OF MEDICINE AND SCIENCE   (United States)

^b ADVOCATE LUTHERAN GENERAL HOSPITAL   (United States)

Author keywords

Amputation; Diabetes; Infection; Prevention; Ulcer

Indexed keywords

ANAMNESIS; ANKLE BRACHIAL INDEX; BIOMECHANICS; CLINICAL TRIAL; DEBRIDEMENT; DEVELOPED COUNTRY; DEVELOPING COUNTRY; DIABETES MELLITUS; DOPPLER FLOWMETRY; FOOT MALFORMATION; FOOT ULCER; HUMAN; INFECTION; INFECTION CONTROL; LEG AMPUTATION; LIMB ISCHEMIA; NEUROPATHY; PATIENT EDUCATION; PHYSICAL EXAMINATION; PRESSURE; PRIMARY MEDICAL CARE; PUBLIC HEALTH; REVIEW; SCREENING; SMOKING CESSATION; VASCULARIZATION; WOUND DRESSING; WOUND HEALING;

ANGIOGENESIS INDUCING AGENTS; BANDAGES; DEBRIDEMENT; DIABETIC ANGIOPATHIES; FOOT ULCER; HUMANS; TREATMENT OUTCOME;

EID: 34249860326     PISSN: 11766344     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (108)

1. Introduction. Healing chronic wounds: 2000. technologic solutions for today and tomorrow. Adv Skin Wound Care, 13(Suppl2):4-5.
2. Living skin substitute can heal diabetic foot ulcer wounds 2000. FDA Consum, 34:6.
3. Peripheral arterial disease in people with diabetes 2003. Diabetes Care, 26:3333-41.
4. Incidence of end-stage renal disease among persons with diabetes - United States, 1990-2002, 2005. MMWR Morb Mortal Wkly Rep, 54:1097-100.
5. Abbott CA, Carrington AL, et al. 2002. The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med, 19:377-84.
6. Armstrong DG. 1999. Loss of protective sensation: a practical evidence-based definition. J Foot Ankle Surg, 38:79-80.
7. Armstrong DG. 2000. The 10-g monofilament: the diagnostic divining rod for the diabetic foot? [editorial] [In Process Citation]. Diabetes Care, 23:887.
8. Armstrong DG, Athanasiou KA 1998. The edge effect: how and why wounds grow in size and depth. Clin Podiatr Med Surg: 105-108.
9. Armstrong DG, Jude EB. 2002. The Role of Matrix Metalloproteinases in Wound Healing. J Amer Podiatr Med Assn. In Press.
10. Armstrong DG, Lavery et al. 2005. Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet, 366(9498):1704-10.
11. Armstrong DG, Lavery LA, et al. 2002. Outcomes of subatmospheric pressure dressing therapy on wounds of the diabetic foot. Ostomy Wound Manage, 48:64-8.
12. Armstrong DG, Lavery LA, et al. 2004. It is not what you put on, but what you take off: techniques for debriding and offloading the diabetic foot wound. Clin Infect Dis, 39:S92-9.
13. Armstrong DG, Lipsky BA. 2004. Advances in the treatment of diabetic foot infections. Diabetes Technol Ther, 6:167-77.
14. Armstrong DG, Peters EJ, et al. 1998. Is there a critical level of plantar foot pressure to identify patients at risk for neuropathic foot ulceration? J Foot Ankle Surg, 37:303-7.
15. Armstrong DG, Stacpoole-Shea S, et al. 1999. Lengthening of the achilles tendon in diabetic patients who are at high risk for ulceration of the foot. J Bone Joint Surg (Am), 81A:535-8.
16. Birke JA, Franks D, et al. 1995. First ray joint limitation, pressure, and ulceration of the first metatarsal head in diabetes mellitus. Foot Ankle, 16:277-84.
17. Birke JA, Novick A, et al. 1991. Methods of treating plantar ulcers. Phys Ther, 71:116-22.
18. Blanke W, Hallern BV. 2003. Sharp wound debridement in local anaesthesia. using EMLA cream: 6 years' experience in 1084 patients. Eur J Emerg Med, 10:229-31.
19. Block P. 1981. The diabetic foot ulcer: a complex problem with a simple treatment approach. Milit Med, 146:644-6.
20. Bonham PA. 2006. Get the LEAD out: noninvasive assessment for lower extremity arterial disease using ankle brachial index and toe brachial index measurements. J Wound Ostomy Continence Nurs, 33:30-41.
21. Boulton AJ. 1996. The pathogenesis of diabetic foot problems: an overview. Diabet Med, 13(Suppl 1):S12-16.
22. Boulton AJ, Vileikyte L. 2000. The diabetic foot: the scope of the problem [In Process Citation]. J Fam Pract, 49(Suppl 11):S3-8.
23. Boulton AJM. 1987. The importance of abnormal foot pressure and gait in causation of foot ulcers. In: Connor H Boulton AJM Ward JD (eds). The foot in diabetes.. Chilchester: John Wiley and Sons. pp 11-26.
24. Boulton AJM, Bowker JH, et al. 1986. Use of plaster casts in the management of diabetic neuropathic foot ulcers. Diabetes Care, 9:149-52.
25. Boyko EJ, Ahroni JH, et al. 1999. A prospective study of risk factors for diabetic foot ulcer. The Seattle Diabetic Foot Study. Diabetes Care, 22:1036-42.
26. Brand PW. 1983. The diabetic foot. In: Ellenberg M Rifkin H (eds). Diabetes mellitus, theory and practice. New York: Medical Examination Publishing. pp 803-28.
27. Brand PW 1991. The insensitive foot (including leprosy). In: Jahss M (ed). Disorders of the Foot and Ankle. Philadelphia: Saunders. pp 2170-5.
28. Brooks B, Dean R, et al. 2001. TBI or not TBI: that is the question. Is it better to measure toe pressure than ankle pressure in diabetic patients? Diabet Med, 18:528-32.
29. Cavanagh PR, Lipsky BA, et al. 2005. Treatment for diabetic foot ulcers. Lancet, 366(9498):1725-35.
30. Cavanagh PR, Ulbrecht JS, et al. 1996. Biomechanical aspects of diabetic foot disease: aetiology, treatment, and prevention. Diabet Med, 13(Suppl 1):S17-22.
31. Coleman W, Brand PW, et al. 1984. The total contact cast, a therapy for plantar ulceration on insensitive feet. J Am Podiatr Med Assoc, 74:548-52.
32. Coppini DV, Young PJ, et al. 1998. Outcome on diabetic foot complications in relation to clinical examination and quantitative sensory testing: a case-control study. Diabet Med, 15:765-71.
33. Dang CN, Boulton AJ. 2003. Changing perspectives in diabetic foot ulcer management. Int J Low Extrem Wounds, 2:4-12.
34. Donaghue VM, Chrzan JS, et al. 1998. Evaluation of a collagen-alginate wound dressing in the management of diabetic foot ulcers. Adv Wound Care, 11:114-19.
35. Duckworth T, Betts RP., et al. 1982. The measurement of pressure under the foot. Foot and Ankle, 3:130.
36. Edmonds ME. 1987. Experience in a multidisciplinary diabetic foot clinic. In: Connor H, Boulton AJM, Ward JD (eds). The foot in diabetes. Chichester: John Wiley and Sons. pp 121-31.
37. Eginton MT, Brown KR., et al. 2003. A prospective randomized evaluation of negative-pressure wound dressings for diabetic foot wounds. Ann Vase Surg, 17:645-9.
38. Embil JM, Papp K, et al. 2000. Recombinant human platelet-derived growth factor-BB (becaplermin) for healing chronic lower extremity diabetic ulcers: an open-label clinical evaluation of efficacy. Wound Repair Regen, 8:162-8.
39. Falanga V. 2004. The chronic wound: impaired healing and solutions in the context of wound bed preparation. Blood Cells Mol Dis, 32:88-94.
40. Fernando, DJS, Masson EA, et al. 1991. Relationship of limited joint mobility to abnormal foot pressures and diabetic foot ulceration. Diabetes Care, 14:8-11.
41. Frykberg RG, Lavery LA., et al. 1998. Role of neuropathy and high foot pressures in diabetic foot ulceration [In Process Citation]. Diabetes Care, 21:1714-19.
42. Gibbons, G. and G. M. Eliopoulos (1984). Infection of the Diabetic Foot. In: Kozak GP Hoar CS Rowbotham JL (eds). Management of Diabetic Foot Problems. Philadelphia: WB Saunders. pp 97-102.
43. Gin H, Rigalleau V, et al. 2002. Comparison between monofilament, tuning fork and vibration perception tests for screening patients at risk of foot complication. Diabetes Metab, 28:457-61.
44. Goldner MG. 1960. The fate of the second leg in the diabetic amputee. Diabetes, 9:100-3.
45. Gough A, Clapperton M, et al. 1997. Randomised placebo-controlled trial of granulocyte-colony stimulating factor in diabetic foot infection. Lancet, 350(9081):855-9.
46. Gregg EW, Sorlie P, et al. 2004. Prevalence of lower-extremity disease in the US adult population ≥40 years of age with and without diabetes: 1999-2000 national health and nutrition examination survey. Diabetes Care, 27:1591-7.
47. Helfand AE. 2003. Assessing and preventing foot problems in older patients who have diabetes mellitus. Clin Podiatr Med Surg, 20:573-82.
48. Helm PA, Walker SC, et al. 1984. Total contact casting in diabetic patients with neuropathic foot ulcerations. Arch Phys Med Rehabil, 65:691-3.
49. Helm PA, Walker SC, et al. 1991. Recurrence of neuropathic ulcerations following healing in a total contact cast. Arch Phys Med Rehabil, 72:967-70.
50. Hopf HW, Humphrey LM., et al. 2001. Adjuncts to preparing wounds for closure: hyperbaric oxygen, growth factors, skin substitutes, negative pressure wound therapy (vacuum-assisted closure). Foot Ankle Clin, 6:661-82.
51. Jude EB, Rogers AA, et al. 2001. Matrix metalloproteinase and tissue inhibitor of metalloproteinase expression in diabetic and venous ulcers. Diabetologia, 44 (Suppl 1):A3.
52. Katz IA, Harlan A, et al. 2005. A randomized trial of two irremovable off-loading devices in the management of plantar neuropathic diabetic foot ulcers. Diabetes Care, 28:555-9.
53. Kominsky SJ. 1991. The ambulatory total contact cast. The high risk foot in diabetes mellitus. F. R. New York: Churchill Livingstone. pp 449-55.
54. Ladwig GP, Robson MC, et al. 2002. Ratios of activated matrix metalloproteinase-9 to tissue inhibitor of matrix metalloproteinase-1 in wound fluids are inversely correlated with healing of pressure ulcers. Wound Repair Regen, 10:26-37.
55. Lavery LA, Armstrong DG, et al. 1998. Practical criteria for screening patients at high risk for diabetic foot ulceration. Arch Intern Med, 158:158-62.
56. Lavery LA, Armstrong DG, et al. 1997. Healing Rates of Diabetic Foot Ulcers Associated with Midfoot Fracture Due to Charcot's Arthropathy." Diabetic Medicine, 14:46-49.
57. Lavery LA, Armstrong, DG et al. 2003. Predictive value of foot pressure assessment as part of a population-based diabetes disease management program. Diabetes Care, 26:1069-73.
58. Lavery LA, Lavery DC, et al. 1995. Increased foot pressures after great toe amputation in diabetes. Diabetes Care, 18:1460-2.
59. Lavery LA, Vela SA, et al. 1996. Reducing dynamic foot pressures in high-risk diabetic subjects with foot ulcerations. A comparison of treatments. Diabetes Care, 19:818-21.
60. Lavery LA, Wunderlich RP, et al. 2005. Disease management for the diabetic foot: effectiveness of a diabetic foot prevention program to reduce amputations and hospitalizations. Diabetes Res Clin Pract, 70:31-7.
61. Lewis R, Whiting P, et al. 2001. A rapid and systematic review of the clinical effectiveness and cost-effectiveness of debriding agents in treating surgical wounds healing by secondary intention. Health Technol Assess, 5:1-131.
62. Litzelman DK, Slemenda CW, et al. 1993. Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus. A randomized, controlled trial. Ann Intern Med, 119:36-41.
63. Malone JM, Snyder M, et al. 1989. Prevention of amputation by diabetic education. Am J Surg, 158:520-3; discussion 523-4.
64. Mason J, O'Keeffe C, et al. 1999. A systematic review of foot ulcer in patients with Type 2 diabetes mellitus. II: treatment. Diabet Med, 16:889-909.
65. Mayfield JA, Reiber GE, et al. 1996. A foot risk classification system to predict diabetic amputation in pima indians. Diabetes Care, 19:704-9.
66. Mayfield JA, Reiber GE, et al. 2000. Do foot examinations reduce the risk of diabetic amputation? J Fam Pract, 49:499-504.
67. Mayfield JA, Reiber GE, et al. 2003. Preventive foot care in people with diabetes. Diabetes Care, 26(Suppl 1):S78-9.
68. Mendonca DA, Cosker T, et al. 2005. Vacuum-assisted closure to aid wound healing in foot and ankle surgery. Foot Ankle Int, 26:761-6.
69. Moreland ME, Kilbourne AM, et al. 2004. Diabetes preventive care and non-traumatic lower extremity amputation rates. J Healthc Qual, 26:12-7.
70. Myerson M, Papa J, et al. 1992. The total contact cast for management of neuropathic plantar ulceration of the foot. J Bone Joint Surg, 74A:261-9.
71. Nwomeh BC, Liang HX, et al. 1999. MMP-8 is the predominant collagenase in healing wounds and nonhealing ulcers. J Surg Res, 81:189-95.
72. Olaleye D, Perkins BA, et al. 2001. Evaluation of three screening tests and a risk assessment model for diagnosing peripheral neuropathy in the diabetes clinic. Diabetes Res Clin Pract, 54:115-28.
73. Omugha N, Jones AM 2003. The management of hard-to-heal necrobiosis with PROMOGRAN. Br J Nurs, 12(Suppl 15):S14-20.
74. Parameswaran GI, Brand K, et al. 2005. Pulse oximetry as a potential screening tool for lower extremity arterial disease in asymptomatic patients with diabetes mellitus. Arch Intern Med, 165:442-6.
75. Pecoraro RE, Reiber GE, et al. 1990. Pathways to diabetic limb amputation: basis for prevention. Diabetes Care, 13:513-21.
76. Peters EJ, Lavery LA. 2001. Effectiveness of the diabetic foot risk classification system of the International Working Group on the Diabetic Foot. Diabetes Care, 24:1442-7.
77. Pham HT, Armstrong DG, et al. 2000. Screening techniques to identify the at risk patients for developing diabetic foot ulcers in a prospective multicenter trial. Diabetes Care, 23:606-11.
78. Pham HT, Economides PA, et al. 1998. The role of endothelial function on the foot. Microcirculation and wound healing in patients with diabetes. Clin Podiatr Med Surg, 15:85-93.
79. Pinzur MS, Slovenkai MP, et al. 2005. Guidelines for diabetic foot care: recommendations endorsed by the Diabetes Committee of the American Orthopaedic Foot and Ankle Society. Foot Ankle Int, 26:113-19.
80. Plank J, Haas W, et al. 2003. Evaluation of the impact of chiropodist care in the secondary prevention of foot ulcerations in diabetic subjects. Diabetes Care, 26:1691-5.
81. Ragnarson Tennvall G, Apelqvist J. 2004. Health-economic consequences of diabetic foot lesions. Clin Infect Dis, 39(Suppl 2):S132-9.
82. Rees RS, Robson MC, et al. 1999. Becaplermin gel in the treatment of pressure ulcers: a phase II randomized, double-blind, placebo-controlled study. Wound Repair Regen, 7:141-7.
83. Reiber GE. 2001. Epidemiology of foot ulcers and amputations in the diabetic foot. In: J. Bowker H, Pfeifer MA (eds). The Diabetic Foot. St. Louis: Mosby. pp 13-32.
84. Reiber GE, Vileikyte L, et al. 1999. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care, 22:157-62.
85. Rith-Najarian SJ, Stolusky T, et al. 1992. Identifying diabetic patients at risk for lower extremity amputation in a primary health care setting. Diabetes Care, 15:1386-9.
86. Ronnemaa T, Hamalainen H, et al. 1997. Evaluation of the impact of podiatrist care in the primary prevention of foot problems in diabetic subjects. Diabetes Care, 20:1833-7.
87. Schaper NC, Apelqvist J, et al. 2003. The international consensus and practical guidelines on the management and prevention of the diabetic foot. Curr Diab Rep, 3:475-9.
88. Schwegler B, Boni T, et al. 2002. [Practical management of diabetic foot]. Ther Umsch, 59:435-42.
89. Sinacore DR, Mueller MJ, et al. 1987. Diabetic plantar ulcers treated by total contact casting. Phys Ther, 67:1543-7.
90. Singh N, Armstrong DG, et al. 2005. Preventing foot ulcers in patients with diabetes. JAMA, 293:217-28.
91. Smith D, Weinberger M, et al. 1987. A controlled trial to increase office visits and reduce hospitalization in diabetic patients. J General Int Med, 2:232-8.
92. Sorman E, Edwall LL. 2002. [Examination of peripheral sensibility. Vibration test is more sensitive than monofilament test]. Lakartidningen, 99:1339-40.
93. Steed DL. 1995. Clinical evaluation of recombinant human platelet-derived growth factor for the treatment of lower extremity diabetic ulcers. Diabetic Ulcer Study Group. J Vasc Surg, 21:71-8.
94. Steed DL. 2004. Debridement. Am J Surg, 187:71S-74S.
95. Steed DL, Donohoe D, et al. 1996. Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. Diabetic Ulcer Study Group. J Am Coll Surg, 183:61-4.
96. Stockl K, Vanderplas A, et al. 2004. Costs of lower-extremity ulcers among patients with diabetes. Diabetes Care, 27:2129-34.
97. Thompson FJ, Veves A, et al. 1991. A team approach to diabetic foot care- the Manchester experience. Foot, 1:75-82.
98. Uccioli L, Faglia E, et al. 1995. Manufactured shoes in the prevention of diabetic foot ulcers. Diabetes Care, 18:1376-8.
99. Van Damme H, Limet R. 2005. [The diabetic foot]. Rev Med Liege, 60:516-25.
100. Veves A, Falanga V, et al. 2001. Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers: a prospective randomized multicenter clinical trial. Apligraf Diabetic Foot Ulcer Study. Diabetes Care, 24:290-5.
101. Veves A, Murray HJ, et al. 1992. The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. Diabetolgica, 35:660-3.
102. Vin F, Teot, et al. 2002. The healing properties of Promogran in venous leg ulcers. J Wound Care, 11:335-41.
103. Walker SC, Helm PA, et al. 1985. Chronic diabetic neuropathic foot ulcerations and total contact casting: healing effectiveness and outcome probability [abstract]. Arch Phys Med Rehabil, 66:574.
104. Walker SC, Helm PA, et al. 1987. Total contact casting and chronic diabetic neuropathic foot ulcerations: healing rates by wound location. Arch Phys Med Rehabil, 68:217-21.
105. Wu SC, Crews RT, et al. 2005. The pivotal role of offloading in the management of neuropathic foot ulceration. Curr Diab Rep, 5:423-9.
106. Wysocki AB, Staiano-Coico L, et al. 1993. Wound fluid from chronic leg ulcers contains elevated levels of metalloproteinases MMP-2 and MMP-9. J Invest Dermatol, 101:64-8.
107. Yager DR, Zhang LY, et al. 1996. Wound fluids from human pressure ulcers contain elevated matrix metalloproteinase levels and activity compared to surgical wound fluids. J Invest Dermatol, 107:743-8.
108. Young MJ, Breddy JL, et al. 1994. The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds. A prospective study. Diabetes Care, 17:557-60.