Roberts RHR, Davies-Jones GR, Brock J, Satheesh V, Robertson GA. Surgical management of the diabetic foot: The current evidence. World J Orthop 2024; 15(5): 404-417 [PMID: 38835689 DOI: 10.5312/wjo.v15.i5.404]
Corresponding Author of This Article
Richard Henry Randall Roberts, BSc, MBChB, Doctor, Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Croesnewydd Rd, Wrexham LL13 7TD, United Kingdom. richard.roberts@doctors.org.uk
Research Domain of This Article
Orthopedics
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. May 18, 2024; 15(5): 404-417 Published online May 18, 2024. doi: 10.5312/wjo.v15.i5.404
Surgical management of the diabetic foot: The current evidence
Richard Henry Randall Roberts, Gareth Rhys Davies-Jones, James Brock, Vaishnav Satheesh, Greg AJ Robertson
Richard Henry Randall Roberts, James Brock, Vaishnav Satheesh, Greg AJ Robertson, Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Wrexham LL13 7TD, United Kingdom
Gareth Rhys Davies-Jones, Greg AJ Robertson, Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry SY10 7AG, United Kingdom
Author contributions: Roberts RHR and Robertson GA conceptualised the review; Roberts RHR, Davies-Jones GR, Brock J and Satheesh V contributed to the writing process; Roberts RHR and Robertson GA contributed significantly to the editing process, refining the manuscript for clarity and consistency; All authors reviewed the final manuscript before submission.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Richard Henry Randall Roberts, BSc, MBChB, Doctor, Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Croesnewydd Rd, Wrexham LL13 7TD, United Kingdom. richard.roberts@doctors.org.uk
Received: January 31, 2024 Revised: March 12, 2024 Accepted: April 24, 2024 Published online: May 18, 2024 Processing time: 104 Days and 15.8 Hours
Abstract
The prevalence of diabetes mellitus and its associated complications, particularly diabetic foot pathologies, poses significant healthcare challenges and economic burdens globally. This review synthesises current evidence on the surgical management of the diabetic foot, focusing on the interplay between neuropathy, ischemia, and infection that commonly culminates in ulcers, infections, and, in severe cases, amputations. The escalating incidence of diabetes mellitus underscores the urgency for effective management strategies, as diabetic foot complications are a leading cause of hospital admissions among diabetic patients, significantly impacting morbidity and mortality rates. This review explores the pathophysiological mechanisms underlying diabetic foot complications and further examines diabetic foot ulcers, infections, and skeletal pathologies such as Charcot arthropathy, emphasising the critical role of early diagnosis, comprehensive management strategies, and interdisciplinary care in mitigating adverse outcomes. In addressing surgical interventions, this review evaluates conservative surgeries, amputations, and reconstructive procedures, highlighting the importance of tailored approaches based on individual patient profiles and the specific characteristics of foot pathologies. The integration of advanced diagnostic tools, novel surgical techniques, and postoperative care, including offloading and infection control, are discussed in the context of optimising healing and preserving limb function.
Core Tip: As diabetes prevalence escalates globally, the associated increase in diabetic foot complications, such as neuropathic and ischemic ulcerations and Charcot neuroarthropathy, necessitates advanced surgical management strategies to prevent limb amputations and reduce mortality. The intricate interplay of diabetes-induced neuropathy and vascular insufficiency in the foot requires a multidisciplinary approach, emphasizing the importance of early diagnosis, comprehensive treatment, and adherence to evolving guidelines. This review highlights the latest advancements in surgical interventions and underscores the critical role of interdepartmental collaboration in optimizing patient outcomes and minimizing the economic burden on healthcare systems
