Feature Article

The diabetic foot. From ulcer to infection



© patrycja/stock.adobe.com
© patrycja/stock.adobe.com


Diabetic foot disease is a serious and common complication of diabetes mellitus that is associated with infection, delayed wound healing and increased risk of limb amputation. GP assessment, based on examination and history, will determine patient treatment and management. Classification tools, such as the Wound, Ischemia and foot Infection classification system, are useful in guiding GPs through assessment and when referral to a podiatrist or specialist is warranted.

Key Points

  • Diabetic foot complications are the most common cause of ‘nontraumatic’ lower limb amputation.
  • The combination of foot deformity, loss of protective sensation, dry skin, inadequate offloading and repetitive minor trauma can lead to tissue damage and ulceration.
  • Once an ulcer has formed, healing may be delayed or not occur, particularly if significant ischaemia is present.
  • Peripheral artery disease is common in patients with diabetes and associated with delayed wound healing.
  • Conventional methods of assessing tissue perfusion in the peripheral circulation are frequently unreliable in patients with diabetes.
  • Wound, Ischemia and foot Infection classification should be used for assessing limb staging in the diabetic foot.
  • The principles of management of diabetic patients with foot ulcers include offloading, wound management, management of infection, assessment of perfusion and revascularisation if required.