Evidence-based management of diabetic foot problems

At present we are experiencing a rapid rise in the global prevalence of diabetes and unfortunately, this is associated with an increase in many of the late complications of diabetes, particularly diabetic foot ulcers which have a significant impairment on quality of life as well as being associated with increased morbidity and mortality. The potential for preventing first and recurrent foot ulcers is reviewed particularly related to recent developments in smart technology and remote monitoring of foot temperature and pressures under high-risk feet. Recent trials on both these areas are reviewed and show promise for the future. Pharmacological approaches to reduce the incidence of foot ulcers are then considered and the small section on the potential role of fibrates which certainly demands further investigation. With respect to treatment of complex foot ulcers, a number of recent evidence-based therapies are described including sucrose octasulfate dressings, negative pressure wound therapy and topical wound oxygen therapy. Lastly, appropriate care and management of infected DFUs is considered particularly focusing on the area of osteomyelitis. A number of excellent recent Guidelines and related reviews are then listed to help readers further understand this rapidly developing and complex area.