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. 2020 Jul 6:8:tkaa017.
doi: 10.1093/burnst/tkaa017. eCollection 2020.

Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition)

Aiping Wang  1 , Guozhong Lv  2 , Xingbo Cheng  3 , Xianghua Ma  4   5 , Wei Wang  6 , Jianchao Gui  7 , Ji Hu  8 , Meng Lu  1 , Guoping Chu  2 , Jin'an Chen  1 , Hao Zhang  4 , Yiqiu Jiang  7 , Yuedong Chen  1 , Wengbo Yang  7 , Lin Jiang  4 , Houfa Geng  5 , Rendong Zheng  9 , Yihui Li  1 , Wei Feng  10 , Boey Johnson  11 , Wenjuan Wang  12 , Dalong Zhu  6 , Yin Hu  10
Affiliations

Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition)

Aiping Wang et al. Burns Trauma. .

Abstract

In recent years, as living standards have continued to improve, the number of diabetes patients in China, along with the incidence of complications associated with the disease, has been increasing. Among these complications, diabetic foot disease is one of the main causes of disability and death in diabetic patients. Due to the differences in economy, culture, religion and level of medical care available across different regions, preventive and treatment methods and curative results for diabetic foot vary greatly. In multidisciplinary models built around diabetic foot, the timely assessment and diagnosis of wounds and appropriate methods of prevention and treatment with internal and external surgery are key to clinical practice for this pathology. In 2019, under the leadership of the Jiangsu Medical Association and Chinese Diabetes Society, the writing group for the Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition) was established with the participation of scholars from the specialist areas of endocrinology, burn injury, vascular surgery, orthopedics, foot and ankle surgery and cardiology. Drawing lessons from diabetic foot guidelines from other countries, this guide analyses clinical practices for diabetic foot, queries the theoretical basis and grades and gives recommendations based on the characteristics of the pathology in China. This paper begins with assessments and diagnoses of diabetic foot, then describes treatments for diabetic foot in detail, and ends with protections for high-risk feet and the prevention of ulcers. This manuscript covers the disciplines of internal medicine, surgical, nursing and rehabilitation and describes a total of 50 recommendations that we hope will provide procedures and protocols for clinicians dealing with diabetic foot.

Keywords: Ankle-brachial index; Diabetic complication; Diabetic foot disease; Diabetic foot infection; Diabetic foot osteomyelitis; Diabetic peripheral neuropathy; Peripheral arterial disease; Randomized controlled trials; Recommendation; Transcutaneous oxygen pressure.

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Figures

Figure 1.
Figure 1.
Monofilament test sites include plantar aspect of the distal first toe and the plantar aspects of the first and fifth metatarsophalangeal joints
Figure 2.
Figure 2.
(a) The examiner places the monofilament perpendicular to the skin surface. (b) The examiner applies enough force to buckle the monofilament
Figure 3.
Figure 3.
The tuning fork is held perpendicular to the skin and placed over the distal aspect of the first toe
Figure 4.
Figure 4.
The examiner evaluates pain by pressing the patient's skin from proximal to toenail with a disposable 40-g pressure needle or pin
Figure 5.
Figure 5.
Specific steps for assessing the Achilles tendon reflex. (a) Patient is maintained in a supine position with the knee flexed and abducted. (b) The examiner holds the patient's toe in slight dorsiflexion. (c) The examiner taps the Achilles tendon with a tendon hammer. (d) The normal reaction is gastrocnemius contraction and foot flexion to plantar surface
Figure 6.
Figure 6.
Tip-Therm specific steps. (a) The examiner places the warm end (34–45°C) over the skin surface of the instep. (b) The examiner places the cold end (5–10°C) over the skin surface of the instep
Figure 7.
Figure 7.
The diagnostic procedure for diabetic foot
Figure 8.
Figure 8.
Foot nerve block
Figure 9.
Figure 9.
Femoral–inferior popliteal artery inverted saphenous vein bypass
Figure 10.
Figure 10.
Mallet toe, hammer toe and claw toe (up) and operation method (down) which is to remove the shadow
Figure 11.
Figure 11.
Osteotomy for phalangeal osteomyelitis after removal of shaded section, using Kirschner wire fixation
Figure 12.
Figure 12.
First metatarsophalangeal joint resection
Figure 13.
Figure 13.
Weil osteotomy of the metatarsal head
Figure 14.
Figure 14.
Multiple metatarsal head resection. The shaded part is cut off and the dotted line is the cut line
Figure 15.
Figure 15.
Medial column fusion surgery
Figure 16.
Figure 16.
Triple articular joint fusion
Figure 17.
Figure 17.
Free anterior tibial flap
Figure 18.
Figure 18.
Dorsal island flap of foot
Figure 19.
Figure 19.
Medial island flap of the foot
Figure 20.
Figure 20.
Relax tension skin lines
Figure 21.
Figure 21.
Achilles tendon lengthening (ATL); the dotted line on the left represents the incision line and the figure on the right represents the operation after ATL
Figure 22.
Figure 22.
Dorsiflexion metatarsal osteotomy
Figure 23.
Figure 23.
Percutaneous flexor tenotomy
Figure 24.
Figure 24.
Distal metatarsal metaphyseal osteotomy
Figure 25.
Figure 25.
Distal metatarsal diaphyseal osteotomy
See this image and copyright information in PMC

References

    1. Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis (dagger). Ann Med. 2017;49:106–16. - PubMed
    1. Bus SA, van Netten JJ, Lavery LA, Monteiro-Soares M, Rasmussen A, Jubiz Y, et al. IWGDF guidance on the prevention of foot ulcers in at-risk patients with diabetes. Diabetes Metab Res Rev. 2016;32:16–24. - PubMed
    1. Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376:2367–75. - PubMed
    1. Wang A, Xu Z, Mu Y, Ji L. Clinical characteristics and medical costs in patients with diabetic amputation and nondiabetic patients with nonacute amputation in central urban hospitals in China. Int J Low Extrem Wounds. 2014;13:17–21. - PubMed
    1. American Diabetes A Economic costs of diabetes in the U.S. in 2017. Diabetes Care. 2018;41:917–28. - PMC - PubMed