Chapter V: Diabetic foot

Area of Science:

• Vascular Surgery
• Diabetology
• Podiatry

Background:

• Diabetic foot ulcers are complex, often resulting from a triad of ischaemia, neuropathy, and infection.
• Peripheral arterial disease in diabetic patients is frequently underestimated due to atypical ischaemic symptoms.
• Microvascular dysfunction significantly impedes the healing of neuroischaemic ulcers.

Purpose of the Study:

• To highlight the underestimated role of peripheral arterial disease in diabetic foot ulceration.
• To emphasize the need for lower revascularization thresholds in neuroischaemic ulcers compared to purely ischaemic ones.
• To advocate for a paradigm shift in diabetic foot care, focusing on vascular impairment.

Main Methods:

• Review of existing literature on diabetic foot ulcer management.
• Analysis of the aetiological triad: ischaemia, neuropathy, and infection.
• Emphasis on early referral, non-invasive vascular testing, imaging, and intervention.

Main Results:

• Neuroischaemic ulcers require specific management strategies often overlooked by current guidelines.
• A significant paucity of comparable data exists for diagnosing and treating neuroischaemic diabetic feet.
• Current recommendations for these cases are often based on low-grade evidence.

Conclusions:

• Diabetic foot ulcers should be presumed to have vascular impairment until proven otherwise.
• A multidisciplinary approach, including vascular surgeons, is essential for optimal patient outcomes.
• New strategies and focused research are urgently needed to improve healing rates and prevent amputations in patients with diabetic foot ulcers and vascular impairment.