Guidelines Summary
The American Diabetes Association guidelines for management of diabetes include these general recommendations for foot care [24] :
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Feet inspected at every visit for patients with evidence of sensory loss or prior ulceration or amputation and comprehensive foot evaluation for others at least annually to identify risk factors for ulcers and amputations.
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Foot examination should include inspection of the skin, assessment of foot deformities, neurologic assessment, and vascular assessment including pulses in the legs and feet.
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Patients with symptoms of claudication or decreased or absent pulses should be referred for ankle-brachial index and for further vascular assessment as appropriate.
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A multidisciplinary approach is required for management of foot ulcers and high-risk feet (eg, dialysis patients and those with Charcot foot, prior ulcers, or amputation).
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For diabetic patients with smoking history or who have prior history of lower extremity complications, loss of protective sensations, structural abnormalities or peripheral artery disease should be referred to foot care specialist for ongoing preventive care and lifelong surveillance.
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General preventive foot selfcare education should be given to all patients with diabetes.
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The use of specialized footwear is recommended for high-risk patients with diabetes including those with severe neuropathy, foot deformities or history of amputation.
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Wounds without evidence of soft-tissue or bone infection do not require antibiotic therapy.
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Empiric antibiotic therapy can be narrowly targeted at gram-positive cocci in acute infections.
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Chronic, previously treated, or severe infections require broad-spectrum regimens and should be referred to specialized care centers.
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Bullous disease of diabetes (bullosis diabeticorum). Tense noninflammatory bulla on the leg.
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Bullous disease of diabetes (bullosis diabeticorum). Unroofed blister on the leg. Note the irregular shape.
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Bullous disease of diabetes (bullosis diabeticorum). Histology of bullosis diabeticorum showing a noninflammatory blister with a subepidermal and focally intraepidermal separation (hematoxylin and eosin stain).
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Bullous disease of diabetes (bullosis diabeticorum). High-power view of the dermis beneath the blister showing capillary wall thickening (hematoxylin and eosin stain).
