The acute diabetic foot: different clinical patterns with a dedicated fast-track pathway

Although scientific societies have made substantial efforts through the implementation of guidelines and by increasing awareness among both expert and non-expert healthcare professionals (HCPs), delayed referral of patients with diabetic foot ulcers (DFUs) to specialized diabetic foot services (DFS) remains a common issue. Early referral to a DFS has been widely documented as the most important intervention for achieving ulcer healing, reducing healing time, and avoiding major amputations. Furthermore, it has been reported that many HCPs working in primary care are not adequately trained in the recognition and management of DFUs. The onset of a DFU may rapidly deteriorate and evolve into a diabetic foot attack (DFA), a dangerous condition characterized by advanced ischaemia, severe infection, and/or acute Charcot neuroarthropathy, potentially leading to limb- and life-threatening consequences. The current document aims to identify the main clinical patterns of DFA, describing their clinical characteristics, appropriate management pathways, and indications for treatment. Accordingly, the authors aimed to develop a practical, fast-track model to define referral timing to specialized diabetic foot centers based on the severity of each clinical presentation. The proposed fast-track approach distinguishes between emergency conditions requiring immediate management within hours and urgent conditions requiring specialist evaluation within 24-48 h to prevent clinical deterioration and poorer outcomes.This document was developed on behalf of the Italian Diabetic Foot Study Group of Società Italiana di Diabetologia (SID) and Associazione Medici Diabetologi (AMD) with the aim of reducing cases of delayed referral and their severe consequences.