Diabetes-Related Foot Disease

Diabetes-related foot disease was redefined in 2023 by the International Working Group on the Diabetic Foot as the disease of the foot of a person suffering from diabetes mellitus that includes one or more of the following: peripheral neuropathy, peripheral artery disease, infection, skin ulcer, neuro-osteoarthropathy, gangrene, and amputation. A multidisciplinary team is necessary for the management of those complex patients including endocrinologists and dermatologists. The dermatologist’s role is related to the recognition and prevention of the apparition and development of ulcers that can ultimately necessitate amputation. Screening, clinical evaluations, early referral, and education of the patient and caregivers are pivotal, revealing foot lesions that can evolve dramatically demanding meticulous clinical examination to identify the risk factors. Investigations performed for the evaluation of the patient with diabetes-related foot disease include the 10-g monofilament test, the ankle-brachial index testing, ultrasound examination, and others. The classification of foot ulcers is difficult, but several systems are in use for a more accurate treatment and prognosis: the site, ischemia, neuropathy, bacterial infection, and depth (SINBAD) system, the society for vascular surgery classification system for wound, ischemia, and foot infection (SVS WIfI) classification system, and the IDSA/IWGDF (Infectious Diseases Society of America/International Working Group on the Diabetic Foot) classification. The management of diabetes-related foot disease involves eliminating or mitigating risk factors, treating existing disorders (neuropathy, arteriopathy, and infections), preventing future injuries, treating existing lesions, and educating the patient on proper foot care.