Diabetes is increasingly common, and is associated with significant patient morbidity, mortality and high socioeconomic costs (Table I). Due to the increasing prevalence of diabetes, almost all clinicians will treat patients who suffer from it, or will treat a direct complication of diabetes. One of the most serious complications affecting orthopaedic surgeons is the diabetic foot ulcer (DFU). The aim of this review is to update clinicians on the optimal management of the DFU.
Aetiology of DFU
Diabetes is a metabolic disease characterised by hyperglycaemia as a result of defects in insulin secretion or action. In the long-term this leads to damage and dysfunction of organs, specifically the eyes, kidneys, heart, nerves and blood vessels.4 A break in the skin on the foot in the presence of diabetes is known as a diabetic foot ulcer (DFU), and is the leading cause of hospitalisation in patients with diabetes (Fig. 1).5,6
There are multiple risk factors for the development of a DFU (Table II).5 The most common reasons are related to neuropathy, vasculopathy or a combination of both.7⇓-9 The vast majority of DFU seen in clinics or presenting as emergencies have combined pathology, and only 10% of DFU are due to isolated vasculopathy or peripheral vascular disease (PVD).10
Diabetes is thought to cause damage to the vasa nervorum resulting in an ischaemic insult and a progressive irreversible sensory, motor and autonomic neuropathy. Most presentations of sensory neuropathy are insidious until the onset of complications. The sensory deficit usually occurs below the knee, is denser distally and is bilateral. Sensory deficit results in numbness of the feet with burning, pain or paraesthesia being …