Diabetic foot ulcer: A comprehensive review of pathophysiology and management modalities

Abstract

Diabetic foot ulcer (DFU) is a debilitating and severe manifestation of uncontrolled and prolonged diabetes that presents as ulceration, usually located on the plantar aspect of the foot. Approximately 15% of individuals with diabetes will eventually develop DFU, and 14%-24% of them will require amputation of the ulcerated foot due to bone infection or other ulcer-related complications. The pathologic mechanisms underlying DFU are comprise a triad: Neuropathy, vascular insufficiency, and secondary infection due to trauma of the foot. Standard local and invasive care along with novel approaches like stem cell therapy pave the way to reduce morbidity, decrease amputations, and prevent mortality from DFU. In this manuscript, we review the current literature with focus on the pathophysiology, preventive options, and definitive management of DFU.

Keywords: Diabetes; Ulcer; Foot; Antibiotics; Revascularization; Cell therapy

Core Tip: Diabetic foot ulcer: Pathophysiology: - Neuropathy including sensory and motor - Vascular insufficiency leading to ischemia - Secondary infection with inflammation. Overview of management: (1) Preventive care including self-screening, health care screening, insoles, podiatric care; (2) Noninvasive modalities including wound dressing, human skin equivalent, topical growth factors, shock wave therapy, stem cell therapy, hyperbaric oxygen, negative pressure, shock wave therapy, maggot therapy, antibiotics; and (3) Invasive modalities including debridement, revascularization, skin grafting, amputation.