Journal of Korean Foot and Ankle Society (대한족부족관절학회지)

Korean Foot & Ankle Society (대한족부족관절학회)
권호 표지
DOI QR코드

DOI QR Code

Management of Diabetic Foot Ulcer

당뇨병성 족부 궤양의 치료

  • Seo, Dong-Kyo (Department of Orthopaedic Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Lee, Ho Seong (Department of Orthopaedic Surgery, Asan Medical Center, Ulsan University College of Medicine)
  • 서동교 (울산대학교 의과대학 서울아산병원 정형외과학교실) ;
  • 이호승 (울산대학교 의과대학 서울아산병원 정형외과학교실)
  • Received : 2014.01.23
  • Accepted : 2014.02.03
  • Published : 2014.03.15
Download PDF
⟨ Previous Next ⟩

Abstract

In patients with diabetic foot, ulceration and amputation are the most serious consequences and can lead to morbidity and disability. Peripheral arterial sclerosis, peripheral neuropathy, and foot deformities are major causes of foot problems. Foot deformities, following autonomic and motor neuropathy, lead to development of over-pressured focal lesions causing the diabetic foot to be easily injured within the shoe while walking. Wound healing in these patients can be difficult due to impaired phagocytic activity, malnutrition, and ischemia. Correction of deformity or shoe modification to relieve the pressure of over-pressured points is necessary for ulcer management. Application of selective dressings that allow a moist environment following complete debridement of the necrotic tissue is mandatory. In the case of a large soft tissue defect, performance of a wound coverage procedure by either a distant flap operation or a skin graft is necessary. Patients with a Charcot joint should be stabilized and consolidated into a plantigrade foot. The bony prominence of a Charcot foot can be corrected by a bumpectomy in order to prevent ulceration. The most effective management of the diabetic foot is ulcer prevention: controlling blood sugar levels and neuropathic pain, smoking cessation, stretching exercises, frequent examination of the foot, and appropriate education regarding footwear.

Keywords

References

  1. Kim DJ. The epidemiology of diabetes in Korea. Diabetes Metab J. 2011;35:303-8. https://doi.org/10.4093/dmj.2011.35.4.303
  2. Kim JM, Kim DY, Woo JT, Kim SW, Yang IM, Kim JW, et al. A clinical study on the diabetic foot lesions. J Korean Diabetes Assoc. 1993;17:387-94.
  3. Wagner FW. A classification and treatment program for diabetics, neuropathic and dysvascular foot problems. Instr Course Lect. 1979;28:143-4.
  4. Coughlin MJ, Mann RA, Saltzman CL. Surgery of the foot and ankle. 8th ed. Philadelphia: Mosby; 2007.
  5. Mann RA, Wapner KL. Tibial sesamoid shaving for treatment of intractable plantar keratosis. Foot Ankle. 1992;13:196-8. https://doi.org/10.1177/107110079201300405
  6. Lin SS, Lee TH, Wapner KL. Plantar forefoot ulceration with equinus deformity of the ankle in diabetic patients: the effect of tendo-Achilles lengthening and total contact casting. Orthopedics. 1996;19:465-75.
  7. Cullen BD, Weinraub GM, Van Gompel G. Early results with use of the midfoot fusion bolt in Charcot arthropathy. J Foot Ankle Surg. 2013;52:235-8. https://doi.org/10.1053/j.jfas.2012.12.003
  8. Grant WP, Garcia-Lavin S, Sabo R. Beaming the columns for Charcot diabetic foot reconstruction: a retrospective analysis. J Foot Ankle Surg. 2011;50:182-9. https://doi.org/10.1053/j.jfas.2010.12.002
  9. Assal M, Ray A, Stern R. Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy. Surgical technique. J Bone Joint Su rg Am. 2010;92 Suppl 1 Pt 1:20-31. https://doi.org/10.2106/JBJS.I.01288
  10. Berendt AR, Lipsky B. Is this bone infected or not? Differentiating neuro-osteoarthropathy from osteomyelitis in the diabetic foot. Curr Diab Rep. 2004;4:424-9. https://doi.org/10.1007/s11892-004-0051-3
  11. Ertugrul BM, Lipsky BA, Savk O. Osteomyelitis or Charcot neuro-osteoarthropathy? Differentiating these disorders in diabetic patients with a foot problem. Diabet Foot Ankle. 2013;4. doi: 10.3402/dfa.v4i0.21855.
  12. Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA. 2002; 287:2570-81. https://doi.org/10.1001/jama.287.19.2570
  13. Kim KW. Diabetic Foot. J Korean Med Assoc. 2007;50:447-54. https://doi.org/10.5124/jkma.2007.50.5.447
  14. Apelqvist J, Castenfors J, Larsson J, Stenstrom A, Agardh CD. Prognostic value of systolic ankle and toe blood pressure levels in outcome of diabetic foot ulcer. Diabetes Care. 1989;12:373-8. https://doi.org/10.2337/diacare.12.6.373
  15. Donas KP, Torsello G, Schwindt A, Schonefeld E, Boldt O, Pitoulias GA. Below knee bare nitinol stent placement in highrisk patients with critical limb ischemia is still durable afte r 24 months of follow-up. J Vasc Surg. 2010;52:356-61. https://doi.org/10.1016/j.jvs.2010.02.281
  16. Bamberger DM, Daus GP, Gerding DN. Osteomyelitis in the feet of diabetic patients. Long-term results, prognostic factors, an d the role of antimicrobial and surgical therapy. Am J Med. 1987; 83:653-60. https://doi.org/10.1016/0002-9343(87)90894-1
  17. Prosdocimi M, Bevilacqua C. Impaired wound healing in diabetes: the rationale for clinical use of hyaluronic acid plus s ilver sulfadiazine. Minerva Med. 2012;103:533-9.
  18. Valenzuela-Silva CM, Tuero-Iglesias AD, Garcia-Iglesias E, Gonzalez-Diaz O, Del Rio-Martin A, Yera Alos IB, et al. Granulation response and partial wound closure predict healing in clinical trials on advanced diabetes foot ulcers treated with recombinant human epidermal growth factor. Diabetes Care. 2013;36: 210-5. https://doi.org/10.2337/dc12-1323
  19. Madhok BM, Vowden K, Vowden P. New techniques for wound debridement. Int Wound J. 2013;10:247-51. https://doi.org/10.1111/iwj.12045
  20. Richmond NA, Maderal AD, Vivas AC. Evidence-based management of common chronic lower extremity ulcers. Dermatol Ther. 2013;26:187-96. https://doi.org/10.1111/dth.12051
  21. Mendonca DA, Cosker T, Makwana NK. Vacuum-assisted closure to aid wound healing in foot and ankle surgery. Foot Ankle Int. 2005;26:761-6. https://doi.org/10.1177/107110070502600915
  22. Malhotra S, Bello E, Kominsky S. Diabetic foot ulcerations: biomechanics, charcot foot, and total contact cast. Semin Vasc Surg. 2012;25:66-9. https://doi.org/10.1053/j.semvascsurg.2012.05.001
  23. Pinzur MS, Lio T, Posner M. Treatment of Eichenholtz stage I Charcot foot arthropathy with a weightbearing total contact cast. Foot Ankle Int. 2006;27:324-9. https://doi.org/10.1177/107110070602700503
  24. Keast DH, Vair AH. Use of the charcot restraint orthotic walker in treatment of neuropathic foot ulcers: a case series. Adv Skin Wound Care. 2013;26:549-52. https://doi.org/10.1097/01.ASW.0000437640.22278.2e
  25. Oh TS, Lee HS, Hong JP. Diabetic foot reconstruction using free flaps increases 5-year-survival rate. J Plast Reconstr Aesthet Surg. 2013;66:243-50. https://doi.org/10.1016/j.bjps.2012.09.024
  26. Wheat LJ, Allen SD, Henry M, Kernek CB, Siders JA, Kuebler T, et al. Diabetic foot infections. Bacteriologic analysis. Arch Intern Med. 1986;146:1935-40. https://doi.org/10.1001/archinte.1986.00360220079017
  27. Kwon YJ, Han KA, Sung SK, Yoo HJ. A Clinical study on the diabetic foot lesions. J Korean Diabetes Assoc. 1989;13:39-46.
  28. Ku BJ, Choi DE, Jeong JO, Rha SY, Lee HJ, Hong WJ, et al. The clinical observations in diabetic patients with foot ulcer. Dia betes Monit. 2002;3:244-52.
  29. Malone M, Bowling FL, Gannass A, Jude EB, Boulton AJ. Deep wound cultures correlate well with bone biopsy culture in diabetic foot osteomyelitis. Diabetes Metab Res Rev. 2013;29:546-50.

Cited by

  1. 당뇨병성 궤양에 사용되는 레이저의 특성에 대한 연구 vol.29, pp.4, 2016, https://doi.org/10.6114/jkood.2016.29.4.014
  2. Neurogenic Pain Disorder in the Foot and Ankle: Peripheral Neuropathy vol.52, pp.4, 2014, https://doi.org/10.4055/jkoa.2017.52.4.305
  3. 당뇨병성 궤양의 레이저치료에 대한 효과 : 체계적 문헌고찰 vol.30, pp.4, 2014, https://doi.org/10.6114/jkood.2017.30.4.062
  4. The Relationship between Body Mass Index and Diabetic Foot Ulcer, Sensory, Blood Circulation of Foot on Type II Diabetes Mellitus Patients vol.53, pp.2, 2014, https://doi.org/10.4055/jkoa.2018.53.2.136
  5. 단일엽 회전 피판술을 이용한 당뇨병성 전족부 궤양의 치료: 5예 보고 vol.23, pp.4, 2014, https://doi.org/10.14193/jkfas.2019.23.4.208
  6. A Case of Charcot Neuroarthropathy Improved by Korean Medical Treatment Combined with Shudihuangkushen-tang and Haifu-san Wet Dressing vol.33, pp.3, 2014, https://doi.org/10.6114/jkood.2020.33.3.125
  7. Treatment of diabetic foot ulcers vol.64, pp.8, 2014, https://doi.org/10.5124/jkma.2021.64.8.529