Diabetic foot: clinical approach

INTRODUCTION: As the diabetes epidemic continues to grow, the proportion of patients that are likely to develop a diabetic foot ulcer (DFU) is also rising. DFU are the main cause of non-traumatic lower extremity amputation. Of note, diabetes-related lower limb complications represent a leading cause of disability and are strongly associated to an increased risk of premature death, which is even higher than the pooled five-year mortality for all reported cancers. Moreover, the high recurrence rate of DFU leads to consider these patients as in remission instead of healed after wound closure, binding them to a lifelong follow-up. Thus, DFU and their complications pose a significant personal, social and financial burden. EVIDENCEACQUISITION: Key word searches were conducted on PubMed, Google Scholar and Web of Science. Selected keywords included "diabetic foot ulcer," "diabetic foot syndrome," "diabetes" in combination with "lower extremity/limb amputation," "peripheral artery disease," "infection," "peripheral neuropathy." EVIDENCESYNTHESIS: This narrative review will provide an extensive overview of current clinical strategies in DF care, encompassing the management of the loss of protective sensation, critical limb ischemia, infection and patients' comorbidities. CONCLUSIONS: The pathogenesis of DF is extremely complex, involving macrovascular and microvascular disease, peripheral neuropathy, structural changes, susceptibility to infection and impaired wound healing. The DF treatment is equally complex, demanding for a multidisciplinary care team. The cornerstones of DFU management are pressure offloading, restoration of perfusion, eradication of infection, optimization of glycemic control and treatment of comorbidities, optimization of wound care and extensive education of patients and their family.