Clinical Research on Foot & Ankle
Open Access

Diabetic foot is a serious complication of diabetes mellitus that results from neuropathy, peripheral arterial disease, and infection. It is a leading cause of non-traumatic lower limb amputations worldwide. This article explores the pathophysiology, risk factors, clinical manifestations, preventive strategies, and management approaches for diabetic foot [1]. Diabetic foot is a significant public health concern, affecting millions of people globally. It is estimated that approximately 15-25% of diabetic patients will develop foot ulcers during their lifetime. These ulcers can lead to severe infections, gangrene, and ultimately, limb amputation [2]. Understanding the underlying mechanisms and preventive strategies can significantly reduce morbidity and mortality associated with diabetic foot. Diabetes mellitus (DM) is a chronic metabolic disorder characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Among its many complications, diabetic foot disease is one of the most debilitating and costly [3]. The term “diabetic foot” refers to a complex array of conditions, including diabetic foot ulcers (DFUs), infections, and Charcot neuroarthropathy. Diabetic foot complications significantly reduce the quality of life for affected individuals and represent a major burden on healthcare systems worldwide. According to the International Diabetes Federation (IDF), approximately 15-25% of individuals with diabetes will develop a foot ulcer during their lifetime, and the risk of lower-limb amputation is 15-46 times higher in people with diabetes than in those without the disease [4].

The pathophysiology of diabetic foot disease is multifactorial and complex. It typically arises due to a combination of peripheral neuropathy, peripheral arterial disease (PAD), and a compromised immune response. Peripheral neuropathy, a common complication of long-term hyperglycemia, leads to sensory loss, motor impairment, and autonomic dysfunction, making patients vulnerable to foot injuries that often go unnoticed [5]. Vascular impairment caused by PAD further exacerbates the condition by reducing blood flow to the extremities, impairing wound healing, and increasing the risk of ischemia. Moreover, diabetes-associated immune dysfunction predisposes patients to chronic infections, which are often polymicrobial and difficult to treat. Preventing diabetic foot complications is a critical component of diabetes management. Early identification of risk factors, routine foot examinations, patient education, and preventive interventions are essential. Effective prevention strategies include glycemic control, appropriate footwear, daily foot care, and smoking cessation. In high-risk individuals, regular screening and timely intervention can significantly reduce the risk of ulcers and amputations [6].

Management of diabetic foot complications requires a multidisciplinary approach. Treatment strategies typically involve wound care, infection control, revascularization, offloading pressure, and, in some cases, surgical intervention. Advanced therapies, such as negative pressure wound therapy (NPWT), hyperbaric oxygen therapy (HBOT), and skin grafting, have shown promising results in promoting wound healing. The role of emerging technologies, including bioengineered skin substitutes, stem cell therapy, and wearable sensors for continuous foot monitoring, is increasingly being recognized in modern diabetic foot care [7].

As the global prevalence of diabetes continues to rise, addressing diabetic foot complications has become a public health priority. Despite advancements in prevention and management, diabetic foot disease remains a major cause of morbidity and mortality. This paper aims to explore the underlying pathophysiology of diabetic foot disease, examine evidence-based preventive strategies, and discuss current and emerging management approaches. By enhancing understanding and promoting proactive care, healthcare professionals can mitigate the impact of diabetic foot disease, ultimately improving outcomes and quality of life for individuals with diabetes [8].

The development of diabetic foot ulcers and infections is a multifactorial process that involves:

Peripheral neuropathy

Chronic hyperglycemia leads to nerve damage, which results in loss of protective sensations in the feet. This makes individuals prone to minor trauma and pressure sores.

Diabetes accelerates atherosclerosis, leading to reduced blood supply to the extremities. Poor perfusion impairs wound healing and increases the risk of infection.

Diabetic patients have impaired immune function, which reduces their ability to fight infections. Neutrophil dysfunction and poor glycemic control contribute to severe infections and delayed healing.

Neuropathy-induced muscle imbalance can lead to foot deformities such as claw toes and Charcot foot, increasing the risk of ulcer formation.

Risk factors for diabetic foot

• Long-standing diabetes mellitus
• Poor glycemic control
• Smoking and tobacco use
• Obesity
• History of foot ulcers or amputations
• Poor foot hygiene
• Ill-fitting footwear
• Peripheral vascular disease

Diabetic foot presents with a variety of symptoms, depending on the severity of the condition. These include:

• Numbness or tingling sensations
• Foot ulcers (often painless due to neuropathy)
• Skin discoloration or blackened tissue (indicative of gangrene)
• Swelling and warmth around ulcers
• Pus discharge and foul-smelling infections

Prevention of diabetic foot

Preventing diabetic foot complications requires a multidisciplinary approach, including regular screening and patient education. Key preventive strategies include:

• Daily inspection of feet for cuts, blisters, or sores
• Washing feet with mild soap and lukewarm water, followed by thorough drying
• Moisturizing feet (except between the toes) to prevent dryness and cracks
• Wearing well-fitted, cushioned shoes
• Avoiding walking barefoot
• Using orthotic insoles for pressure redistribution

Maintaining optimal blood sugar levels reduces the risk of neuropathy and infections.

• Annual foot screening for all diabetic patients
• Evaluation of peripheral pulses and sensory loss using monofilament testing

Management of Diabetic Foot

Treatment of diabetic foot involves both medical and surgical interventions based on the severity of the condition.

• Debridement of necrotic tissue
• Use of topical antiseptics and dressings
• Administration of broad-spectrum antibiotics for infected ulcers
• Use of special footwear or total contact casting to relieve pressure from ulcerated areas
• Revascularization procedures in cases of severe PAD
• Amputation in cases of gangrene or severe infections unresponsive to treatment

Use of growth factors and stem cell therapy for wound healing

Hyperbaric oxygen therapy to enhance oxygen delivery to ischemic tissues

Conclusion

Diabetic foot is a major complication of diabetes that can lead to severe disability and mortality. Early identification, effective preventive measures, and prompt management can significantly reduce the burden of the disease. A multidisciplinary approach involving endocrinologists, podiatrists, vascular surgeons, and wound care specialists is crucial for improving patient outcomes. Diabetic foot disease is a serious and often preventable complication of diabetes mellitus, with profound consequences for affected individuals and healthcare systems. Its pathophysiology is driven by a complex interplay of neuropathy, vascular disease, and immune dysfunction, which together create a vulnerable environment for foot injuries, chronic wounds, and severe infections. Without timely and appropriate management, diabetic foot ulcers can lead to devastating outcomes, including lower-limb amputations, disability, and increased mortality rates. Prevention remains the cornerstone of diabetic foot care. Comprehensive foot care programs, routine screenings, patient education, and risk factor modification strategies have been shown to significantly reduce the incidence of foot ulcers and associated complications. Encouraging self-care practices, such as daily foot inspection, proper footwear selection, and glycemic control, empowers patients to actively participate in their own preventive care.

Effective management of diabetic foot disease requires a multidisciplinary and individualized approach. Wound debridement, infection control, pressure offloading, and revascularization are essential components of standard care. Advanced wound therapies, including bioengineered skin, growth factors, and negative pressure wound therapy, have improved healing rates and reduced the need for amputations. Additionally, the integration of emerging technologies, such as telemedicine, remote monitoring, and wearable devices, offers new opportunities for early detection and personalized care.

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