Diabetic foot ulcers: a review of current management


  • Yasmee Khan Department of General Medicine, AIIMS Bhopal, Madhya Pradesh, India
  • Manal M. Khan Department of Burns and Plastic Surgery, AIIMS Bhopal, Madhya Pradesh, India
  • M. Raza Farooqui Departement of Surgery, MMC, Muzaffarnagar, Uttar Pradesh, India




Classification, Debridement, Diabetic foot management, Diabetic foot ulcers, Offloading


Diabetic foot ulcers are a serious complication of diabetes mellitus which increases the patient morbidity and also have significant socioeconomic impact. The present review aims to summarize the causes and pathogenesis leading to diabetic foot ulcers, various classification systems and to focus on the current management of this significant and preventable health condition.


Bakker K, Riley PH. The year of the diabetic foot. Diabetes Voice. 2005;50(1):11-4.

Harris MI, Flegal KM, Cowie CC, Eberhardt MS, Goldstein DE, Little RR, Wiedmeyer HM, Byrd-Holt DD. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in US adults: the Third National Health and Nutrition Examination Survey, 1988–1994. Diabetes care. 1998;21(4):518-24.

Complications in newly diagnosed type II diabetic patients and their association with different clinical and biochemical risk factors. Diabetes Res 1990; 13:1 -11.

Diabetes Control and Complications Trial Research Group. The relationship of glycemic exposure (HbA 1c) to the risk of development and progression of retinopathy in the Diabetes Control and Complications Trial. Diabetes. 1995;44(8):968-83.

Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. Bmj. 2000;321(7258):405-12.

Nathan DM, Mc Kitrick C, Larkin M et al. Glycemic control in diabetes mellitus: have changes in therapy made a difference? Am J Med 1996; 100: 157-63.

Mayfield JA, Reiber GE, Sanders LJ, Janisse D, Pogach LM. Preventive foot care in people with diabetes. Diabetes Care. 2001;24:S56.

International Diabetes Federation. The Global Burden. IDF Diabetes Atlas.2012:5.

Frykberg RG, Zgonis T, Armstrong DG, Driver VR, Giurini JM, Kravitz SR, Landsman AS, Lavery LA, Moore JC, Schuberth JM, Wukich DK. Diabetic foot disorders: a clinical practice guideline (2006 revision). J foot and ankle surg. 2006;45(5):S1-66.

Bortoletto MS, de Andrade SM, Matsuo T, Haddad MD, González AD, Silva AM. Risk factors for foot ulcers—a cross sectional survey from a primary care setting in Brazil. Primary care diabetes. 2014;8(1):71-6.

Waaijman R, de Haart M, Arts ML, Wever D, Verlouw AJ, Nollet F, Bus SA. Risk factors for plantar foot ulcer recurrence in neuropathic diabetic patients. Diabetes care. 2014;37(6):1697-705.

Monteiro‐Soares M, Boyko EJ, Ribeiro J, Ribeiro I, Dinis‐Ribeiro M. Predictive factors for diabetic foot ulceration:a systematic review. Diabetes/metabolism research and reviews. 2012 Oct 1;28(7):574-600.

Alavi A, Sibbald RG, Mayer D, Goodman L, Botros M, Armstrong DG, Woo K, Boeni T, Ayello EA, Kirsner RS. Diabetic foot ulcers: part II. Management. J Americ Acad Dermatol. 2014;70(1):21-e1.

Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. The Lancet. 2005;366(9498):1719-24.

Formosa C, Gatt A, Chockalingam N. Diabetic foot complications in Malta: prevalence of risk factors. The Foot. 2012;22(4):294-7.

Sawacha Z, Gabriella G, Cristoferi G, Guiotto A, Avogaro A, Cobelli C. Diabetic gait and posture abnormalities: a biomechanical investigation through three dimensional gait analysis. Clinical biomechanics. 2009;24(9):722-8.

Jones EW, Peacock I, McLain S, Fletcher E, Edwards R, Finch RG, Jeffcoate WJ. A Clinico‐pathological Study of Diabetic Foot Ulcers. Diabetic medicine. 1987;4(5):475-9.

Lavery LA, Armstrong DG, Harkless LB. Classification of diabetic foot wounds. J Foot and Ankle Surg. 1996;35(6):528-31.

Spraul M. Education—Can It Prevent Diabetic Foot Ulcers and Amputations?. The Foot in Diabetes, Third Edition. 2000:111-20.

Sibbald RG. Cost–effective faster wound healing of critically colonized wounds with a sustained release silver foam dressing, based upon the symposium” Bacteria, sustained release of silver and improved healing”, An official satellite symposium of the WUWHS 2004. Published at www. worldwidewounds. Com:2005.

Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. Harrison's principles of internal medicine, 19e. USA2015. 2015.

Lebrun E, Tomic‐Canic M, Kirsner RS. The role of surgical debridement in healing of diabetic foot ulcers. Wound repair and regeneration. 2010;18(5):433-8.

Smith RG. Enzymatic debriding agents: an evaluation of the medical literature. Ostomy/wound management. 2008;54(8):16-34.

Margolin L, Gialanella P. Assessment of the antimicrobial properties of maggots. Int wound J. 2010;7(3):202-4.

American Diabetes Association. Consensus Development Conference on Diabetic Foot Wound Care: 7-8 April 1999, Boston, Massachusetts. American Diabetes Association. Diabetes care. 1999;22(8):1354-60.

Hilton JR, Williams DT, Beuker B, Miller DR, Harding KG. Wound dressings in diabetic foot disease. Clinical Infectious Diseases. 2004;39(Supplement_2):S100-3.

Schultz GS, Sibbald RG, Falanga V, Ayello EA, Dowsett C, Harding K, Romanelli M, Stacey MC, Teot L, Vanscheidt W. Wound bed preparation: a systematic approach to wound management. Wound repair and regeneration. 2003;11(s1).

European Wound Management Association (EWMA). Position document: Wound bed preparation in practice. London: MEP Ltd, 2004. Available at http://woundsinternational.com Accessed March 2013.

Cavanagh PR, Bus SA. Off-loading the diabetic foot for ulcer prevention and healing. J vascular surg. 2010;52(3):37S-43S.

Frykberg RG, Lavery LA, Pham H, Harvey C, Harkless L, Veves A. Role of neuropathy and high foot pressures in diabetic foot ulceration. Diabetes care. 1998;21(10):1714-9.

Xie X, McGregor M, Dendukuri N. The clinical effectiveness of negative pressure wound therapy: a systematic review. J wound care. 2010;19(11).

Broussard CL. Hyperbaric oxygenation and wound healing. J vascular Nurs. 2004;22(2):42-8.

Roeckl‐Wiedmann I, Bennett M, Kranke P. Systematic review of hyperbaric oxygen in the management of chronic wounds. Brit J Surg. 2005;92(1):24-32.

Edmonds M, Bates M, Doxford M, Gough A, Foster A. New treatments in ulcer healing and wound infection. Diabetes/metabolism research and reviews. 2000;16(S1).

Ehrenreich M, Ruszczak Z. Update on tissueengineered biological dressings. Tissue Eng.2006; 12:2407–24.

Brem H, Sheehan P, Rosenberg HJ, Schneider JS, Boulton AJ. Evidence-based protocol for diabetic foot ulcers. Plastic and reconstructive surgery. 2006;117(7S):193S-209S.

Attinger CE, Ducic I, Cooper P, Zelen CM. The role of intrinsic muscle flaps of the foot for bone coverage in foot and ankle defects in diabetic and nondiabetic patients. Plastic and reconstructive surgery. 2002;110(4):1047-54.

Pallua N, Di Benedetto G, Berger A. Forefoot reconstruction by reversed island flaps in diabetic patients. Plast Reconstr Surg 2000;106:823-7.

Laborde JM. Treatment of diabetic foot ulcers with tendon lengthening. American family physician. 2009 Dec;80(12):1351.




How to Cite

Khan, Y., M. Khan, M., & Raza Farooqui, M. (2017). Diabetic foot ulcers: a review of current management. International Journal of Research in Medical Sciences, 5(11), 4683–4689. https://doi.org/10.18203/2320-6012.ijrms20174916



Review Articles