Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition)
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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.
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参考文献
(149) [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. [2] 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. [3] Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376:2367–75. [4] 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. [5] American Diabetes A. Economic costs of diabetes in the U.S. in 2017. Diabetes Care. 2018;41:917–28. [6] International Working Group on the Diabetic Foot. IWGDF guidelines on the prevention and management of diabetic foot disease [Internet]. Available from: https://iwgdfguidelines.org/wp-content/uploads/2019/05/IWGDF-Guidelines-2019 .[7] Chinese Diabetes Society, Society of Infectious Disease, Chinese Medical Association of Organization Repair and Regeneration Branch. Chinese guidelines for the prevention and treatment of diabetic foot (2019 edition) (in Chinese). Chinese Journal of Diabetes. 2019;11:92–108. [8] Lin EH, Rutter CM, Katon W, Heckbert SR, Ciechanowski P, Oliver MM, et al. Depression and advanced complications of diabetes: a prospective cohort study. Diabetes Care. 2010;33:264–9. [9] Raspovic KM, Ahn J, La Fontaine J, Lavery LA, Wukich DK. End-stage renal disease negatively affects physical quality of life in patients with diabetic foot complications. Int J Low Extrem Wounds 2017;16:135–42. [10] Lee WS, Kim J. Diabetic cardiomyopathy: where we are and where we are going. Korean J Intern Med. 2017;32:404–21. [11] Ozer Balin S, Sagmak Tartar A, Ugur K, Kilinc F, Telo S, Bal A, et al. Pentraxin-3: a new parameter in predicting the severity of diabetic foot infection?. Int Wound J. 2019;16:659–64. [12] Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, et al. 2012 infectious diseases society of america clinical practice guideline for the diagnosis and treatment of diabetic foot infections. J Am Podiatr Med Assoc. 2013;103:2–7. [13] Fridman R, Bar-David T, Kamen S, Staron RB, Leung DK, Rasiej MJ. Imaging of diabetic foot infections. Clin Podiatr Med Surg. 2014;31:43–56. [14] Nawaz A, Torigian DA, Siegelman ES, Basu S, Chryssikos T, Alavi A. Diagnostic performance of FDG-PET, MRI, and plain film radiography (PFR) for the diagnosis of osteomyelitis in the diabetic foot. Mol Imaging Biol. 2010;12:335–42. [15] Saeed S, Zafar J, Khan B, Akhtar A, Qurieshi S, Fatima S, et al. Utility of (9)(9) mTc-labelled antimicrobial peptide ubiquicidin (29-41) in the diagnosis of diabetic foot infection. Eur J Nucl Med Mol Imaging. 2013;40:737–43. [16] Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54:e132–73. [17] Lavery LA, Ryan EC, Ahn J, Crisologo PA, Oz OK, La Fontaine J, et al. The infected diabetic foot: re-evaluating the IDSA diabetic foot infection classification. Clin Infect Dis. 2020;70:1573–79. https://doi.org/10.1093/cid/ciz489. [18] Monteiro-Soares M, Boyko EJ, Ribeiro J, Ribeiro I, Dinis-Ribeiro M. Predictive factors for diabetic foot ulceration: a systematic review. Diabetes Metab Res Rev. 2012;28:574–600. [19] Hinchliffe RJ, Brownrigg JR, Apelqvist J, Boyko EJ, Fitridge R, Mills JL, et al. IWGDF guidance on the diagnosis, prognosis and management of peripheral artery disease in patients with foot ulcers in diabetes. Diabetes Metab Res Rev. 2016;32:37–44. [20] Hingorani A, LaMuraglia GM, Henke P, Meissner MH, Loretz L, Zinszer KM, et al. The management of diabetic foot: a clinical practice guideline by the Society for Vascular Surgery in collaboration with the American podiatric medical association and the Society for Vascular Medicine. J Vasc Surg. 2016;63:3S–21S. [21] Armstrong DW, Tobin C, Matangi MF. The accuracy of the physical examination for the detection of lower extremity peripheral arterial disease. Can J Cardiol. 2010;26:e346–50. [22] Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. 2016 AHA/ACC guideline on the Management of Patients with lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2017;135:e726–79. [23] Aboyans V, Criqui MH, Abraham P, Allison MA, Creager MA, Diehm C, et al. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation. 2012;126:2890–909. [24] Del Conde I, Benenati JF. Noninvasive testing in peripheral arterial disease. Interv Cardiol Clin. 2014;3:469–78. [25] Andersen CA. Noninvasive assessment of lower extremity hemodynamics in individuals with diabetes mellitus. J Vasc Surg. 2010;52:76S–80S. [26] Redlich U, Xiong YY, Pech M, Tautenhahn J, Halloul Z, Lobmann R, et al. Superiority of transcutaneous oxygen tension measurements in predicting limb salvage after below-the-knee angioplasty: a prospective trial in diabetic patients with critical limb ischemia. Cardiovasc Intervent Radiol. 2011;34:271–9. [27] Wang Z, Hasan R, Firwana B, Elraiyah T, Tsapas A, Prokop L, et al. A systematic review and meta-analysis of tests to predict wound healing in diabetic foot. J Vasc Surg. 2016;63: 29S–36S.e1–2. [28] Eiberg JP, Gronvall Rasmussen JB, Hansen MA, Schroeder TV. Duplex ultrasound scanning of peripheral arterial disease of the lower limb. Eur J Vasc Endovasc Surg. 2010;40:507–12. [29] Schabel C, Bongers MN, Ketelsen D, Syha R, Thomas C, Homann G, et al. Diagnostic accuracy of dual energy CT angiography in patients with diabetes mellitus. Radiologe. 2015;55:314–22. [30] Jeremias Z, Rat N, Benedek I, Rapolti E, Ratiu M, Muresan A, et al. High iliac calcium score is associated with increased severity and complexity of peripheral arterial disease and predicts global atherosclerotic burden. Vasa. 2018;47:377–86. [31] Dias-Neto M, Marques C, Sampaio S. Digital subtraction angiography or computed tomography angiography in the preoperative evaluation of lower limb peripheral artery disease - a comparative analysis. Rev Port Cir Cardiotorac Vasc. 2017;24:174. [32] Menke J, Larsen J. Meta-analysis: accuracy of contrast-enhanced magnetic resonance angiography for assessing steno-occlusions in peripheral arterial disease. Ann Intern Med. 2010;153:325–34. [33] Vinik AI. CLINICAL PRACTICE. Diabetic sensory and motor neuropathy. N Engl J Med. 2016;374:1455–64. [34] Tan LS. The clinical use of the 10g monofilament and its limitations: a review. Diabetes Res Clin Pract. 2010;90: 1–7. [35] Watson JC, Dyck PJ. Peripheral neuropathy: a practical approach to diagnosis and symptom management. Mayo Clin Proc. 2015;90:940–51. [36] Rayman G, Vas PR, Baker N, Taylor CG, Jr, Gooday C, Alder AI, et al. The Ipswich touch test: a simple and novel method to identify inpatients with diabetes at risk of foot ulceration. Diabetes Care. 2011;34:1517–8. [37] Sharma S, Kerry C, Atkins H, Rayman G. The Ipswich touch test: a simple and novel method to screen patients with diabetes at home for increased risk of foot ulceration. Diabet Med. 2014;31:1100–3. [38] Chinese Diabetes Society. Guidelines for the prevention and Treatment of type 2 diabetes in China (2017 edition) (in Chinese). Chinese Journal of Diabetes. 2018;10:4–67. [39] Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care. 2017;40:136–54. [40] Lu B, Hu J, Wen J, Zhang Z, Zhou L, Li Y, et al. Determination of peripheral neuropathy prevalence and associated factors in Chinese subjects with diabetes and pre-diabetes - ShangHai diabetic neuRopathy epidemiology and molecular genetics study (SH-DREAMS). PLoS One. 2013. [41] Callaghan BC, Price RS, Feldman EL. Distal symmetric polyneuropathy: a review. JAMA. 2015;314:2172–81. [42] Tan T, Shaw EJ, Siddiqui F, Kandaswamy P, Barry PW, Baker M, et al. Inpatient management of diabetic foot problems: summary of NICE guidance. BMJ. 2011;342: d1280. [43] Bergin SM, Gurr JM, Allard BP, Holland EL, Horsley MW, Kamp MC, et al. Australian diabetes foot network: management of diabetes-related foot ulceration - a clinical update. Med J Aust. 2012;197:226–9. [44] Hafner J, Nobbe S, Partsch H, Lauchli S, Mayer D, Amann-Vesti B, et al. Martorell hypertensive ischemic leg ulcer: a model of ischemic subcutaneous arteriolosclerosis. Arch Dermatol. 2010;146:961–8. [45] Suarez-Amor O, Perez-Bustillo A, Ruiz-Gonzalez I, Rodriguez-Prieto MA. Necrobiosis lipoidica therapy with biologicals: an ulcerated case responding to etanercept and a review of the literature. Dermatology. 2010;221:117–21. [46] Zhongyang S, Xinjuan S, Jin’an C, Wei W, Lan L, Yinchen C, et al. SIANM assessment: a new assessment method for diabetic foot (in Chinese). Journal of Trauma Surgery. 2017;19: 869–72. [47] Eggert JV, Worth ER, Van Gils CC. Cost and mortality data of a regional limb salvage and hyperbaric medicine program for Wagner grade 3 or 4 diabetic foot ulcers. Undersea Hyperb Med. 2016;43:1–8. [48] Lv HH, Wu S, Liu X, Yang XL, Xu JF, Guan YT, et al. Comparison of VerifyNow P2Y12 and thrombelastography for assessing clopidogrel response in stroke patients in China. Neurol Sci. 2016;37:277–82. [49] Abu-Assi E, Raposeiras-Roubin S, Garcia-Acuna JM, Gonzalez-Juanatey JR. Bleeding risk stratification in an era of aggressive management of acute coronary syndromes. World J Cardiol. 2014;6:1140–8. [50] Hocking G, Mitchell CH. Optimizing the safety and practice of ultrasound-guided regional anesthesia: the role of echogenic technology. Curr Opin Anaesthesiol. 2012;25:603–9. [51] Lai HY, Foo LL, Lim SM, Yong CF, Loh PS, Chaw SH, et al. The hemodynamic and pain impact of peripheral nerve block versus spinal anesthesia in diabetic patients undergoing diabetic foot surgery. Clin Auton Res. 2020;30:53–60. [52] Choi YS, Shin HJ, Park JY, Kim HJ, Yun SH. Ultrasound-guided femoral and popliteal sciatic nerve blocks for below knee surgery in patients with severe cardiac disease. Korean J Anesthesiol. 2015;68:513–5. [53] Visnjevac O, Davari-Farid S, Lee J, Pourafkari L, Arora P, Dosluoglu HH, et al. The effect of adding functional classification to ASA status for predicting 30-day mortality. Anesth Analg. 2015;121:110–6. [54] Carls GS, Gibson TB, Driver VR, Wrobel JS, Garoufalis MG, Defrancis RR, et al. The economic value of specialized lower-extremity medical care by podiatric physicians in the treatment of diabetic foot ulcers. J Am Podiatr Med Assoc. 2011;101:93–115. [55] Somayaji R, Elliott JA, Persaud R, Lim M, Goodman L, Sibbald RG. The impact of team based interprofessional comprehensive assessments on the diagnosis and management of diabetic foot ulcers: a retrospective cohort study. PLoS One. 2017. https://doi.org/10.1371/journal.pone.0185251 [56] Nather A, Siok Bee C, Keng Lin W, Xin-Bei Valerie C, Liang S, Tambyah PA, et al. Value of team approach combined with clinical pathway for diabetic foot problems: a clinical evaluation. Diabet Foot Ankle. 2010. https://doi.org/10.3402/dfa.v1i0.5731. [57] Wang C, Mai L, Yang C, Liu D, Sun K, Song W, et al. Reducing major lower extremity amputations after the introduction of a multidisciplinary team in patient with diabetes foot ulcer. BMC Endocr Disord. 2016. https://doi.org/10.1186/s12902-016-0111-0. [58] Christman AL, Selvin E, Margolis DJ, Lazarus GS, Garza LA. Hemoglobin A1c predicts healing rate in diabetic wounds. J Invest Dermatol. 2011;131:2121–7. [59] Markuson M, Hanson D, Anderson J, Langemo D, Hunter S, Thompson P, et al. The relationship between hemoglobin a(1c) values and healing time for lower extremity ulcers in individuals with diabetes. Adv Skin Wound Care. 2009;22: 365–72. [60] Hasan R, Firwana B, Elraiyah T, Domecq JP, Prutsky G, Nabhan M, et al. A systematic review and meta-analysis of glycemic control for the prevention of diabetic foot syndrome. J Vasc Surg. 2016;63:22S-28S.e2. [61] Kee KK, Nair HKR, Yuen NP. Risk factor analysis on the healing time and infection rate of diabetic foot ulcers in a referral wound care clinic. J Wound Care. 2019;28:S4–S13. [62] Fernando ME, Seneviratne RM, Tan YM, Lazzarini PA, Sangla KS, Cunningham M, et al. Intensive versus conventional glycaemic control for treating diabetic foot ulcers. Cochrane Database Syst Rev. 2016;1:CD010764. https://doi.org/10.1002/14651858.CD010764.pub2 [63] Peled S, Pollack R, Elishoov O, Haze A, Cahn A. Association of Inpatient Glucose Measurements with amputations in patients hospitalized with acute diabetic foot. J Clin Endocrinol Metab. 2019;104:5445–52. [64] Jiang Y, Wang X, Xia L, Fu X, Xu Z, Ran X, et al. A cohort study of diabetic patients and diabetic foot ulceration patients in China. Wound Repair Regen. 2015;23:222–30. [65] Al-Rubeaan K, Al Derwish M, Ouizi S, Youssef AM, Subhani SN, Ibrahim HM, et al. Diabetic foot complications and their risk factors from a large retrospective cohort study. PLoS One. 2015. https://doi.org/10.1371/journal.pone.0124446. [66] Brennan MB, Guihan M, Budiman-Mak E, Kang H, Lobo JM, Sutherland BL, et al. Increasing SBP variability is associated with an increased risk of developing incident diabetic foot ulcers. J Hypertens. 2018;36:2177–84. [67] American Diabetes Association. Cardiovascular disease and risk management: standards of medical Care in Diabetes-2020. Diabetes Care. 2020;43:S111–34. [68] Adamsson Eryd S, Gudbjornsdottir S, Manhem K, Rosengren A, Svensson AM, Miftaraj M, et al. Blood pressure and complications in individuals with type 2 diabetes and no previous cardiovascular disease: national population based cohort study. BMJ. 2016;354:i4070. [69] Xie X, Atkins E, Lv J, Bennett A, Neal B, Ninomiya T, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet. 2016;387:435–43. [70] Emdin CA, Rahimi K, Neal B, Callender T, Perkovic V, Patel A. Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2015;313:603–15. [71] Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387:957–67. [72] The ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362:1575–85. [73] Sink KM, Evans GW, Shorr RI, Bates JT, Berlowitz D, Conroy MB, et al. Syncope, hypotension, and falls in the Treatment of hypertension: results from the randomized clinical systolic blood pressure intervention trial. J Am Geriatr Soc. 2018;66:679–86. [74] Dietrich I, Braga GA, de Melo FG, da Costa Silva Silva ACC. The diabetic foot as a proxy for cardiovascular events and mortality review. Curr Atheroscler Rep. 2017;19. https://doi.org/10.1007/s11883-017-0680-z. [75] Cholesterol Treatment Trialists’ Collaborators, Kearney PM, Blackwell L, Collins R, Keech A, Simes J, et al. Efficacy of cholesterol-lowering therapy in 18, 686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet. 2008;371:117–25. [76] Pei E, Li J, Lu C, Xu J, Tang T, Ye M, et al. Effects of lipids and lipoproteins on diabetic foot in people with type 2 diabetes mellitus: a meta-analysis. J Diabetes Complications. 2014;28:559–64. [77] Cannon CP, Blazing MA, Giugliano RP, McCagg A, White JA, Theroux P, et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med. 2015;372:2387–97. [78] Pignone M, Alberts MJ, Colwell JA, Cushman M, Inzucchi SE, Mukherjee D, et al. Aspirin for primary prevention of cardio-vascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. Diabetes Care. 2010;33:1395–402. [79] Standards of medical Care in Diabetes-2016: summary of revisions. Diabetes Care. 2016;39:S4–5. [80] American Diabetes A. Standards of medical care in diabetes–2014. Diabetes Care. 2014, 2014;37:S14–80. [81] de Antonio M, Lupon J, Galan A, Vila J, Urrutia A, Bayes-Genis A. Combined use of high-sensitivity cardiac troponin T and N-terminal pro-B type natriuretic peptide improves measurements of performance over established mortality risk factors in chronic heart failure. Am Heart J. 2012;163:821–8. [82] Liu H, Zhang YZ, Gao M, Liu BC. Elevation of B-type natriuretic peptide is a sensitive marker of left ventricular diastolic dysfunction in patients with maintenance haemodialysis. Biomarkers. 2010;15:533–7. [83] Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141: e278S–325S. [84] Jara-Palomares L, Marin-Romero S, Asensio-Cruz MI, Elias-Hernandez T, Otero-Candelera R. Intermittent pneumatic compression plus pharmacological thromboprophylaxis to prevent deep vein thrombosis. J Thorac Dis. 2019;11:1731–3. [85] Hou H, Yao Y, Zheng K, Teng H, Rong Z, Chen D, et al. Does intermittent pneumatic compression increase the risk of pulmonary embolism in deep venous thrombosis after joint surgery?. Blood Coagul Fibrinolysis. 2016;27:246–51. [86] Scheeren TW, Wiesenack C, Gerlach H, Marx G. Goal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients: a prospective randomized multicentre study. J Clin Monit Comput. 2013;27: 225–33. [87] Toomtong P, Suksompong S. Intravenous fluids for abdominal aortic surgery. Cochrane Database Syst Rev. 2010;1:CD000991. https://doi.org/10.1002/14651858.CD000991.pub2. [88] Bunn F, Trivedi D. Colloid solutions for fluid resuscitation. Cochrane Database Syst Rev. 2012;7:CD001319. https://doi.org/10.1002/14651858.CD001319.pub5. [89] Romanelli M, Dini V, Milani M. Topical purified omental lipid formulations in the prevention of skin ulcers: a narrative review. J Wound Care. 2019;28:284–90. [90] Nixon J, Brown S, Smith IL, McGinnis E, Vargas-Palacios A, Nelson EA, et al. Comparing alternating pressure mattresses and high-specification foam mattresses to prevent pressure ulcers in high-risk patients: the PRESSURE 2 RCT. Health Technol Assess. 2019;23:1–176. [91] Riemenschneider KJ. Prevention of pressure injuries in the operating room: a quality improvement project. J Wound Ostomy Continence Nurs. 2018;45:141–5. [92] Jiang Y, Ran X, Jia L, Yang C, Wang P, Ma J, et al. Epidemiology of type 2 diabetic foot problems and predictive factors for amputation in China. Int J Low Extrem Wounds. 2015;14:19–27. [93] Kim NY, Lee KY, Bai SJ, Hong JH, Lee J, Park JM, et al. Comparison of the effects of remifentanil-based general anesthesia and popliteal nerve block on postoperative pain and hemodynamic stability in diabetic patients undergoing distal foot amputation: a retrospective observational study. Medicine (Baltimore). 2016. https://doi.org/10.1097/MD.0000000000004302. [94] Fullerton B, Jeitler K, Seitz M, Horvath K, Berghold A, Siebenhofer A. Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus. Cochrane Database Syst Rev. 2014;2:CD009122. https://doi.org/10.1002/14651858.CD009122.pub2. [95] Bragd J, Adamson U, Backlund LB, et al., Can glycaemic variability, as calculated from blood glucose self-monitoring, predict the development of complications in type 1 diabetes over a decade?. [J]. Diabetes Metab. 2008;34:612–6. doi: 10.1016/j.diabet.2008.04.005. [96] Hotta N, Kawamori R, Fukuda M, Shigeta Y, Aldose Reductase Inhibitor-Diabetes Complications Trial Study Group. Long-term clinical effects of epalrestat, an aldose reductase inhibitor, on progression of diabetic neuropathy and other microvascular complications: multivariate epidemiological analysis based on patient background factors and severity of diabetic neuropathy. Diabet Med. 2012;29:1529–33. https://doi.org/10.1111/j.1464-5491.2012.03684.x. [97] Li S, Chen X, Li Q, Du J, Liu Z, Peng Y, et al. Effects of acetyl-L-carnitine and methylcobalamin for diabetic peripheral neuropathy: a multicenter, randomized, double-blind, controlled trial. J Diabetes Investig. 2016;7:777–85. [98] Shin S, Kim KJ, Chang HJ, Lee BW, Yang WI, Cha BS, et al. The effect of oral prostaglandin analogue on painful diabetic neuropathy: a double-blind, randomized, controlled trial. Diabetes Obes Metab. 2013;15:185–8. [99] Jin YP, Su XF, Li HQ, Wu JD, Ding B, Sun R, et al. The therapeutic effect of pancreatic Kininogenase on Treatment of diabetic peripheral neuropathy in patients with type 2 diabetes. Exp Clin Endocrinol Diabetes. 2016;124:618–21. [100] Hossain SM, Hussain SM, Ekram AR. Duloxetine in painful diabetic neuropathy: a systematic review. Clin J Pain. 2016;32:1005–10. [101] Boyle J, Eriksson ME, Gribble L, Gouni R, Johnsen S, Coppini DV, et al. Randomized, placebo-controlled comparison of amitriptyline, duloxetine, and pregabalin in patients with chronic diabetic peripheral neuropathic pain: impact on pain, polysomnographic sleep, daytime functioning, and quality of life. Diabetes Care. 2012;35:2451–8. [102] Derry S, Moore RA. Topical capsaicin (low concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2012;9:CD010111. https://doi.org/10.1002/14651858.CD010111. [103] Elgzyri T, Larsson J, Nyberg P, Thorne J, Eriksson KF, Apelqvist J. Early revascularization after admittance to a diabetic foot center affects the healing probability of ischemic foot ulcer in patients with diabetes. Eur J Vasc Endovasc Surg. 2014;48:440–6. [104] Armstrong DG, Kanda VA, Lavery LA, Marston W, Mills JL, Sr, Boulton AJ. Mind the gap: disparity between research funding and costs of care for diabetic foot ulcers. Diabetes Care. 2013;36:1815–7. [105] Elgzyri T, Larsson J, Thorne J, Eriksson KF, Apelqvist J. Outcome of ischemic foot ulcer in diabetic patients who had no invasive vascular intervention. Eur J Vasc Endovasc Surg. 2013;46:110–7. [106] Alexandrescu VA. Commentary: myths and proofs of angiosome applications in CLI: where do we stand?. J Endovasc Ther. 2014;21:616–24. [107] Acin F, Varela C, Lopez de Maturana I, et al., Results of infrapopliteal endovascular procedures performed in diabetic patients with critical limb ischemia and tissue loss from the perspective of an angiosome-oriented revascularization strategy[J]. Int J Vasc Med. 2014;2014:270539. doi: 10.1155/2014/270539. [108] Kabra A, Suresh KR, Vivekanand V, Vishnu M, Sumanth R, Nekkanti M. Outcomes of angiosome and non-angiosome targeted revascularization in critical lower limb ischemia. J Vasc Surg. 2013;57:44–9. [109] Adam DJ, Beard JD, Cleveland T, Bell J, Bradbury AW, Forbes JF, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366:1925–34. [110] Vogel TR, Dombrovskiy VY, Haser PB, Graham AM. Evaluating preventable adverse safety events after elective lower extremity procedures. J Vasc Surg. 2011;54: 706–13. [111] Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, et al. Corrigendum to ’European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2020;59:454. [112] Lipsky BA, Aragon-Sanchez J, Diggle M, Embil J, Kono S, Lavery L, et al. IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes. Diabetes Metab Res Rev. 2016;32:45–74. [113] Barwell ND, Devers MC, Kennon B, Hopkinson HE, McDougall C, Young MJ, et al. Diabetic foot infection: antibiotic therapy and good practice recommendations. Int J Clin Pract. 2017. https://doi.org/10.1111/ijcp.13006. [114] Hesstvedt L, Arendrup MC, Poikonen E, Klingpor L, Friman V, Nordoy I, et al. Differences in epidemiology of candidaemia in the Nordic countries- what is to blame?. Mycoses. 2017;60:11–9. [115] Johnson SW, Drew RH, May DB. How long to treat with antibiotics following amputation in patients with diabetic foot infections? Are the 2012 IDSA DFI guidelines reasonable?. J Clin Pharm Ther. 2013;38:85–8. [116] Wacker C, Prkno A, Brunkhorst FM, Schlattmann P. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13:426–35. [117] Ahluwalia R, Vainieri E, Tam J, Sait S, Sinha A, Manu CA, et al. Surgical diabetic foot debridement: improving training and practice utilizing the traffic light principle. Int J Low Extrem Wounds. 2019;18:279–86. [118] Wang Z, Zuze W, Xiaobing F. Diagnosis and treatment of diabetic foot (in Chinese). Beijing: People’s Medical Publishing House, 2016, 276. [119] Elraiyah T, Domecq JP, Prutsky G, Tsapas A, Nabhan M, Frykberg RG, et al. A systematic review and meta-analysis of debridement methods for chronic diabetic foot ulcers. J Vasc Surg. 2016;63:37S–45S.e2. [120] Lazaro-Martinez JL, Aragon-Sanchez J, Garcia-Morales E. Antibiotics versus conservative surgery for treating diabetic foot osteomyelitis: a randomized comparative trial. Diabetes Care. 2014;37:789–95. [121] Widatalla AH, Mahadi SE, Shawer MA, Mahmoud SM, Abdelmageed AE, Ahmed ME. Diabetic foot infections with osteomyelitis: efficacy of combined surgical and medical treatment. Diabet Foot Ankle. 2012. https://doi.org/10.3402/dfa.v3i0.18809. [122] Tamir E, Tamir J, Beer Y, Kosashvili Y, Finestone AS. Resection Arthroplasty for resistant ulcers underlying the hallux in insensate diabetics. Foot Ankle Int. 2015;36:969–75. [123] Baumgartner R. Forefoot and midfoot amputations. Oper Orthop Traumatol. 2011;23:254–64. [124] Thorud JC, Jupiter DC, Lorenzana J, Nguyen TT, Shibuya N. Reoperation and Reamputation after Transmetatarsal amputation: a systematic review and meta-analysis. J Foot Ankle Surg. 2016;55:1007–12. [125] Stone PA, Back MR, Armstrong PA, et al., Midfoot amputations expand limb salvage rates for diabetic foot infections[J]. Ann Vasc Surg. 2005;19:805–11. doi: 10.1007/s10016-005-7973-3. [126] Sundararajan SR, Srikanth KP, Nagaraja HS, Rajasekaran S. Effectiveness of Hindfoot arthrodesis by stable internal fixation in various Eichenholtz stages of neuropathic ankle Arthropathy. J Foot Ankle Surg. 2017;56:282–6. [127] Dalla Paola L, Carone A, Boscarino G, Scavone G, Vasilache L. Combination of open subtotal Calcanectomy and stabilization with external fixation as limb salvage procedure in Hindfoot-infected diabetic foot ulcers. Int J Low Extrem Wounds. 2016;15:332–7. [128] Akkurt MO, Demirkale I, Oznur A. Partial calcanectomy and Ilizarov external fixation may reduce amputation need in severe diabetic calcaneal ulcers. Diabet Foot Ankle. 2017. https://doi.org/10.1080/2000625X.2017.1264699. [129] Janis JE, Kwon RK, Attinger CE. The new reconstructive ladder: modifications to the traditional model. Plast Reconstr Surg. 2011;127:205S–12S. [130] Hahn HM, Jeong KS, Park MC, Park DH, Lee IJ. Free-flap transfer for coverage of Transmetatarsal amputation stump to preserve residual foot length. Int J Low Extrem Wounds. 2017;16:60–5. [131] Xiaobing F. Treatment of diabetic foot and associated chronic refractory wounds (in Chinese)[M]. Beijing: Military Science Publishing House, 2013, 81–2. [132] Zhang X, Sun D, Jiang GC. Comparative efficacy of nine different dressings in healing diabetic foot ulcer: a Bayesian network analysis. J Diabetes. 2019;11:418–26. [133] Stoekenbroek RM, Santema TB, Legemate DA, Ubbink DT, van den Brink A, Koelemay MJ. Hyperbaric oxygen for the treatment of diabetic foot ulcers: a systematic review. Eur J Vasc Endovasc Surg. 2014;47:647–55. [134] O’Reilly D, Pasricha A, Campbell K, Burke N, Assasi N, Bowen JM, et al. Hyperbaric oxygen therapy for diabetic ulcers: systematic review and meta-analysis. Int J Technol Assess Health Care. 2013;29:269–81. [135] Li Y, Gao Y, Gao Y, Chen D, Wang C, Liu G, et al. Autologous platelet-rich gel treatment for diabetic chronic cutaneous ulcers: a meta-analysis of randomized controlled trials. J Diabetes. 2019;11:359–69. [136] Sun BK, Siprashvili Z, Khavari PA. Advances in skin grafting and treatment of cutaneous wounds. Science. 2014;346:941–5. [137] Guo J, Dardik A, Fang K, Huang R, Gu Y. Meta-analysis on the treatment of diabetic foot ulcers with autologous stem cells. Stem Cell Res Ther. 2017. https://doi.org/10.1186/s13287-017-0683-2. [138] Hughes OB, Rakosi A, Macquhae F, Herskovitz I, Fox JD, Kirsner RS. A review of cellular and Acellular matrix products: indications, techniques, and outcomes. Plast Reconstr Surg. 2016;138:138S–47S. [139] Lev-Tov H, Li CS, Dahle S, Isseroff RR. Cellular versus acellular matrix devices in treatment of diabetic foot ulcers: study protocol for a comparative efficacy randomized controlled trial. Trials. 2013. https://doi.org/10.1186/1745-6215-14-8. [140] Shekhter AB, Fayzullin AL, Vukolova MN, Rudenko TG, Osipycheva VD, Litvitsky PF. Medical applications of collagen and collagen-based materials. Curr Med Chem. 2019;26:506–16. [141] Wiser I, Tamir E, Kaufman H, Keren E, Avshalom S, Klein D, et al. A novel recombinant human collagen-based Flowable matrix for chronic lower limb wound management: first results of a clinical trial. Wounds. 2019;31:103–7. [142] Begg L, McLaughlin P, Vicaretti M, Fletcher J, Burns J. Total contact cast wall load in patients with a plantar forefoot ulcer and diabetes. J Foot Ankle Res. 2016. https://doi.org/10.1186/s13047-015-0119-0. [143] Morona JK, Buckley ES, Jones S, Reddin EA, Merlin TL. Comparison of the clinical effectiveness of different off-loading devices for the treatment of neuropathic foot ulcers in patients with diabetes: a systematic review and meta-analysis. Diabetes Metab Res Rev. 2013;29:183–93. [144] Bus SA, Armstrong DG, van Deursen RW, Lewis JE, Caravaggi CF, Cavanagh PR, et al. IWGDF guidance on footwear and offloading interventions to prevent and heal foot ulcers in patients with diabetes. Diabetes Metab Res Rev. 2016;32:25–36. [145] Rogers LC, Andros G, Caporusso J, Harkless LB, Mills JL, Sr, Armstrong DG. Toe and flow: essential components and structure of the amputation prevention team. J Vasc Surg. 2010;52:23S–7S. [146] Bakker K, Apelqvist J, Lipsky BA, Van Netten JJ, International Working Group on the Diabetic F. The 2015 IWGDF guidance documents on prevention and management of foot problems in diabetes: development of an evidence-based global consensus. Diabetes Metab Res Rev. 2016;32:2–6. [147] Rizzo L, Tedeschi A, Fallani E, Coppelli A, Vallini V, Iacopi E, et al. Custom-made orthesis and shoes in a structured follow-up program reduces the incidence of neuropathic ulcers in high-risk diabetic foot patients. Int J Low Extrem Wounds. 2012;11:59–64. [148] Scott JE, Hendry GJ, Locke J. Effectiveness of percutaneous flexor tenotomies for the management and prevention of recurrence of diabetic toe ulcers: a systematic review. J Foot Ankle Res. 2016;9:25. [149] Biz C, Gastaldo S, Dalmau-Pastor M, Corradin M, Volpin A, Ruggieri P. Minimally invasive distal metatarsal Diaphyseal osteotomy (DMDO) for chronic plantar diabetic foot ulcers. Foot Ankle Int. 2018;39:83–92. -
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. (a) The examiner places the monofilament perpendicular to the skin surface. (b) The examiner applies enough force to buckle the monofilament
Figure 3. The tuning fork is held perpendicular to the skin and placed over the distal aspect of the first toe
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. 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. Tip-Therm specific steps. (a) The examiner places the warm end (34–45℃) over the skin surface of the instep. (b) The examiner places the cold end (5–10℃) over the skin surface of the instep
Figure 10. Mallet toe, hammer toe and claw toe (up) and operation method (down) which is to remove the shadow
Figure 11. Osteotomy for phalangeal osteomyelitis after removal of shaded section, using Kirschner wire fixation
Figure 14. Multiple metatarsal head resection. The shaded part is cut off and the dotted line is the cut line
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
Table 1. Grades of Recommendation, Assessment, Development and Evaluation system evidence grades
Quality of evidence A (high quality) Very confident that the true effect value approximates the effect estimate B (moderate quality) There is a moderate degree of confidence in the effect estimates, and it is possible that the true value is close to the estimates, but there is still a possibility that the two are quite different C (poor quality) The degree of confidence in the effect estimate is limited and the true value may be quite different from the estimate D (very low quality) There is little confidence in the estimates of effects and the true values are likely to be very different from the estimates Strength of recommendations Level 1 recommendation (strong) The benefits clearly outweigh the risks and the credibility of both clinician implementation and population acceptance is high Level 2 recommendation (weak) The benefits are equal to the risks, depending on the specific clinical situation. In general, the preferences of doctors and patients play a more important role in the decision-making process 
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Table 2. Medical history of diabetic foot patients
General medical history (1) Occupational needs, (2) family history of diabetes, (3) previous hospitalization, (4) surgical history (5) allergies, (6) adverse reactions to anesthetics, (7) nutritional status, (8) quality of life, (9) alcohol, tobacco, depression, (10) diabetes duration, (11) current medications, (12) glycemic management, (13) diabetic complications, (14) diabetic comorbidities, (15) other systemic diseases, (16) patient compliance, (17) doctors Foot-specific history General foot history (1) Foot disease history, (2) treatment history of foot disease, (3) footwear, (4) foot warmth, (5) mechanical or chemical contact, (6) acupuncture or pain in the lower limbs, (7) proximal leg muscle atrophy and weakness, (8) foot deformity, (9) abnormal foot pressure and callosity, (10) lack of joint range of motion, (11) claudication or pain at rest (12) bilateral or unilateral edema Wound/ulcer history (1) Incentives (stimulus time or trauma), (2) duration, (3) recurrence, (4) location, (5) wound care, (6) wound size (length, width and depth), (7) interference with wound care (family or social), (8) offloading techniques
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Table 3. Lower limb physical examination
Dermatologic examination • Color, turgor, wetness, hair growth, chap • Nail atrophy or hypertrophy • Calluses and subcallus hemorrhage • Ulcers (location, size, depth, infection status), gangrene • Others: (1) tinea pedis (fungal infection), paronychia (bacterial infection), itchy with scratch marks (yeast infection), (2) microvascular change, light brown, scaly patches (diabetic dermatopathy), (3) diabetic steatosis, bullous disease, (4) eruptive xanthomatosis, distal sclerosis, disseminated granuloma annulare (5) anaphylaxis Vascular examination • Absence of hair growth, onychodystrophy, thinning skin (parchment-like skin), cyanosis and erythema, postural color change • Temperature gradient (ipsilateral and contralateral extremity) • Abdominal artery to dorsal foot artery auscultation, palpation of femoral artery to dorsal foot artery • Handheld doppler examination Neurologic and musculoskeletal examination • Vibration perception: tuning fork 128 cps, biothesiometer • Light pressure: Semmes-Weinstein 10-gram monofilament • Light touch: cotton wool, two-point discrimination • Pain: pinprick (sterile needle) • Temperature perception: cold and hot • Deep tendon reflexes: patellar and ankle reflexes, clonus testing, Babinski test, Romberg test • Biomechanical abnormalities: (1) structural deformities: hammertoe, bunion, tailor's bunion, hallux limitus, flat or high-arched feet, Charcot deformities, postsurgical deformities (including prior amputation); (2) limited joint mobility; (3) plantar pressure assessment: callus, corns, skin pressure red and other manifestations, computerized devices, Harris ink mat, pressure sensitive foot mat
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Table 4. Different types of ulcers and their clinical manifestation
Subjects Venous ulcer Arterial ulcer Neurogenic ulcer High risk factors Venous valve dysfunction, deep venous thrombosis, prolonged standing, pregnancy, exercise less, obesity, family history High cholesterol, arteriosclerosis, hypertension, diabetes, aging, smoker, thromboangiitis obliterans, arteriovenous fistula Diabetes, peripheral nerve injury Limb change Edema, hyperpigmentation, superficial varicose veins, dry scaly skin, eczematous dermatitis, lymphedema Toenail thickening, pale and dry skin, intermittent lameness, peripheral arterial pulse weaken or disappear, capillary reperfusion time is prolonged(> 3–4 s), Pale skin appeared 1 minute after leg elevation of 45° Sensory dysfunction, foot deformity Location Medial malleolar region: malleolar region, tibia, lower limb under a third Pressure parts or extremity (toe): tiptoe, head of phalanx of toes, lateral malleolus or metatarsal Pressure parts Characteristics Wide range, irregular edges, shallow ulcer, red granulation tissue, less necrotic tissue and more exudate Small scope and clear boundary, deep ulcer, basal paleness, black necrotic tissue, less exudate Deep ulcer with reddish base and easy bleeding Surrounding ulcer skin Hemosiderosis(severe), lipodermatosclerosis Adermotrophia and hair loss, mild pigmentation Thick callosity Pain Mild or moderate pain, pain lessens with lower limb elevation Pain obviously, pain lessens at rest or when the lower limbs are lowered No obvious pain Pulse Normal pulse and skin temperature Lower limbs pulse weakens or disappear and cold skin The pulsating test is not reliable
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Table 5. Texas classification
Texas classification Grade 0: the epidermis is intact before and after ulcer formation Grade 1:superficial ulcers, not involving tendons, joint sacs or bone Grade 2: the wound involves the tendon or capsule of the joint Grade 3: the wound involves bone or joint Stage A: no ischemia or infection A0 A1 A2 A3 Stage B: infection B0 B1 B2 B3 Stage C: ischemia C0 C1 C2 C3 Stage D: ischemia and infection D0 D1 D2 D3
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