Diabetic Foot Care

Excerpt

Diabetes mellitus is a metabolic disease resulting in increased glucose in the bloodstream. Estimates are that there are 451 million individuals with diabetes worldwide and approximately 5 million diabetes-related deaths in 2017 globally.

Patients with diabetes mellitus are at increased risk for pedal ulceration due to microvascular, neuropathic, and biomechanical changes to the foot. Neuropathic changes to the body result in decreased pedal sensation and make the diabetic foot prone to wounds from pressure, mechanical, or pressure injuries. Microvascular changes can result in reduced blood flow to the lower extremity, and delaying healing of wounds.

Hemoglobin A1c is a marker that reflects average blood glucose levels over a 2 to 3 month period. The American Diabetes Association and International Expert Committee agree that a hemoglobin A1c greater than or equal to 6.5% is the recommended level for the diagnosis of diabetes. An increase in HgA1c of 1% has demonstrated to increase peripheral vascular disease risk by 25 to 28%.

Patients with diabetes are at high risk for lower extremity amputations, higher healthcare costs, and lower quality of life. In a systematic regarding non-traumatic amputations of patients with diabetes mellitus and peripheral vascular disease, the 5-year mortality rate of patients after a below-the-knee amputation was 40 to 82%, and mortality after an above-the-knee amputation was 40 to 90%. Many of these complications are preventable by a thorough annual foot exam and routine foot care performed by the patient.

The purpose of this article is to discuss anatomy, indications, equipment, personnel, preparation, technique, complications, and clinical significance of the diabetic foot.