Diabetic foot ulcers : Part I. Pathophysiology and prevention - 18/12/13

Doi : 10.1016/j.jaad.2013.06.055

Afsaneh Alavi, MD, FRCPC ^a,^e,^⁎ , R. Gary Sibbald, MD ^a,^b,^e, Dieter Mayer, MD ^c, Laurie Goodman, RN, MScN ^d, Mariam Botros, Dch ^e, David G. Armstrong, DPM, MD, PhD ^f, Kevin Woo, RN, PhD ^g, Thomas Boeni, MD ^h, Elizabeth A. Ayello, RN, PhD ⁱ, Robert S. Kirsner, MD, PhD ^j
^a Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada
^b Department of Medicine (Dermatology) and Public Health, University of Toronto, Toronto, Ontario, Canada
^c Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
^d Wound-Healing Clinic, Mississauga, Ontario, Canada
^e Wound Care Centre, Women’s College Hospital, Toronto, Ontario, Canada
^f Department of Surgery, the University of Arizona College of Medicine/SALSA, Tucson, Arizona
^g Faculty of Nursing, Queen’s University, Kingston, Ontario, Canada
^h Department of Prosthetics and Orthotics, University of Zurich, Zurich, Switzerland
ⁱ Excelsior College, School of Nursing, Albany, New York
^j Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida

^∗Reprint requests: Afsaneh Alavi, MD, FRCPC, University of Toronto, Women's College Hospital, 76 Grenville St, M5S 1B1, Toronto, ON, Canada.

Abstract

Diabetes mellitus is a serious, life-long condition that is the sixth leading cause of death in North America. Dermatologists frequently encounter patients with diabetes mellitus. Up to 25% of patients with diabetes mellitus will develop diabetic foot ulcers. Foot ulcer patients have an increased risk of amputation and increased mortality rate. The high-risk diabetic foot can be identified with a simplified screening, and subsequent foot ulcers can be prevented. Early recognition of the high-risk foot and timely treatment will save legs and improve patients’ quality of life. Peripheral arterial disease, neuropathy, deformity, previous amputation, and infection are the main factors contributing to the development of diabetic foot ulcers. Early recognition of the high-risk foot is imperative to decrease the rates of mortality and morbidity. An interprofessional approach (ie, physicians, nurses, and foot care specialists) is often needed to support patients’ needs.

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Key words : diabetes, diabetic foot ulcer, neuropathy, wounds