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Review
. 2023 Mar 16;11(8):1669-1683.
doi: 10.12998/wjcc.v11.i8.1669.

Understanding the multifaceted etiopathogenesis of foot complications in individuals with diabetes

Tatjana Matijević  1 , Jasminka Talapko  2 , Tomislav Meštrović  3   4 , Marijan Matijević  5 , Suzana Erić  6   7 , Ivan Erić  6   8 , Ivana Škrlec  9
Affiliations
Review

Understanding the multifaceted etiopathogenesis of foot complications in individuals with diabetes

Tatjana Matijević et al. World J Clin Cases. .

Abstract

Diabetes mellitus, a chronic disease of metabolism, is characterized by a disordered production or cellular utilization of insulin. Diabetic foot disease, which comprises the spectrum of infection, ulceration, and gangrene, is one of the most severe complications of diabetes and is the most common cause of hospitalization in diabetic patients. The aim of this study is to provide an evidence-based overview of diabetic foot complications. Due to neuropathy, diabetic foot infections can occur in the form of ulcers and minor skin lesions. In patients with diabetic foot ulcers, ischemia and infection are the main causes of non-healing ulcers and amputations. Hyperglycemia compromises the immune system of individuals with diabetes, leading to persistent inflammation and delayed wound healing. In addition, the treatment of diabetic foot infections is challenging due to difficulty in accurate identification of pathogenic microorganisms and the widespread issue of antimicrobial resistance. As a further complicating factor, the warning signs and symptoms of diabetic foot problems can easily be overlooked. Issues associated with diabetic foot complications include peripheral arterial disease and osteomyelitis; accordingly, the risk of these complications in people with diabetes should be assessed annually. Although antimicrobial agents represent the mainstay of treatment for diabetic foot infections, if peripheral arterial disease is present, revascularization should be considered to prevent limb amputation. A multidisciplinary approach to the prevention, diagnosis, and treatment of diabetic patients, including those with foot ulcers, is of the utmost importance to reduce the cost of treatment and avoid major adverse consequences such as amputation.

Keywords: Diabetes mellitus; Diabetic foot; Foot ulcer; Infection; Peripheral arterial disease.

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Conflict of interest statement

Conflict-of-interest statement: All authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Clinical presentation of the diabetic foot.
Figure 2
Figure 2
Flow diagram for screening for foot complications in persons with diabetes. ABI: Ankle-brachial index; CRP: C-reactive protein; DSA: Digital subtraction angiography; ESR: Erythrocyte sedimentation rate; TcPO2: Transcutaneous oxygen pressure.
Figure 3
Figure 3
Algorithm for management of diabetic foot ulcer. ABI: Ankle-brachial index; TcPO2: Transcutaneous oxygen pressure.
See this image and copyright information in PMC

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