Update: Diabetic foot disorders: a clinical practice guideline.

• Frykberg RG, Zgonis T, Armstrong DG, Driver VR, Giurini JM, Kravitz SR, Landsman AS, Lavery LA, Moore C, Schuberth JM, Wukick DK, Andersen C, Vanore JV. Diabetic foot disorders: a clinical practice guideline. J Foot Ankle Surg 2006 Sep-Oct;45(5):S2-66. [579 references]

This is the current release of the guideline.

This guideline updates a previous version: Frykberg RG, Armstrong DG, Giurini J, Edwards A, Kravette M, Kravitz S, Ross C, Stavosky J, Stuck R, Vanore J. Diabetic foot disorders: a clinical practice guideline. American College of Foot and Ankle Surgeons. J Foot Ankle Surg 2000;39(5 Suppl):S1-60. [248 references]

• Diabetic foot ulcers
• Diabetic foot infections
• Diabetic Charcot foot

Diagnosis
Evaluation
Management
Prevention
Treatment

Cardiology
Endocrinology
Family Practice
Infectious Diseases
Internal Medicine
Nephrology
Nursing
Orthopedic Surgery
Podiatry
Surgery

Advanced Practice Nurses
Nurses
Physician Assistants
Physicians
Podiatrists

To present clinical practice guidelines on the diagnosis, treatment, management, and prevention of diabetic foot disorders

Patients with diabetes mellitus who have or who are at risk of developing diabetic foot disorders

Diagnosis and Evaluation

1. History (global history, foot-specific history, wound/ulcer history)
2. Clinical examination (vascular, neurologic, musculoskeletal, dermatologic, footwear)
3. Diagnostic procedures:
   • Laboratory testing as indicated
   • Imaging studies (x-rays and other studies as indicated)
   • Vascular procedures (noninvasive arterial studies)
   • Neurologic procedures (e.g., Semmes-Weinstein monofilament)
   • Plantar foot pressure assessment
4. Risk stratification

Prevention

1. Multidisciplinary team approach
2. Patient and family education
3. Regular podiatrist visits
4. Therapeutic shoes
5. Provider education

Management/Treatment of Diabetic Foot Ulcers

1. Management of comorbidities
2. Evaluation of vascular status
3. Assessment of lifestyle/psychosocial factors
4. Ulcer assessment and evaluation
5. Tissue management/wound bed preparation
   • Debridement (surgical/sharp), including control of moisture balance, wound dressing, and assessment of inflammation and infection
   • Pressure relief/off-loading
6. Management of wounds that fail to heal

Management/Treatment of Diabetic Foot Infections

1. Treatment for non-limb threatening infection
   • Antibiotics
   • Cleaning and debridement
2. Treatment for limb-threatening infection
   • Surgical treatment (debridement, draining, open amputation)
   • Antibiotic therapy
   • Microbiologic/histopathologic assessment of bone

Management/Treatment of Charcot Foot

1. Immobilization/stress reduction
2. Progression to weightbearing
3. Special footwear
4. Reconstructive surgery

Prevention of Foot Complications

1. Podiatric care
2. Protective shoes
3. Pressure reduction
4. Prophylactic surgery
5. Preventive education

• Incidence and morbidity of diabetic foot disorders
• Rates of limb salvage and/or diabetic limb amputations