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Review
. 2006 Feb 18;332(7538):407-10.
doi: 10.1136/bmj.332.7538.407.

Diabetic foot ulcers

Michael E Edmonds  1 , A V M Foster
Affiliations
Review

Diabetic foot ulcers

Michael E Edmonds et al. BMJ. .
No abstract available

PubMed Disclaimer

Figures

Figure 1
Figure 1
Left: Neuropathic foot with prominent metatarsal heads and pressure points over the plantar forefoot. Right: Neuroischaemic foot showing pitting oedema secondary to cardiac failure, and hallux valgus and erythema from pressure from tight shoe on medial aspect of first metatarsophalangeal joint
Figure 2
Figure 2
Left: Hand held Doppler used with sphygmomanometer to measure ankle systolic pressure. Right: Doppler waveform from normal foot showing normal triphasic pattern (top) and from neuroischaemic foot showing damped pattern (bottom)
Figure 3
Figure 3
Left: Neuropathic foot with plantar ulcer surrounded by callus. Right: Ulcer over medial aspect of first metatarsophalangeal joint of neuroischaemic foot
Figure 4
Figure 4
Left: Callus removal by sharp debridement. Right: Whitish, macerated, moist tissue under surface of callus, indicating imminent ulceration
Figure 5
Figure 5
Left: Blister under a callus over first metatarsal head. Centre: The roof of the blister is grasped in forceps and cut away, together with associated callus. Right: Ulcer is revealed underneath
Figure 6
Figure 6
Top: Shoe with no proper fastening and with a narrow toe box (left); red marks on toes after wearing unsuitable shoes (right). Left: New ischaemic ulcers resulting from bullae on lateral margin of foot
Figure 6
Figure 6
Top: Shoe with no proper fastening and with a narrow toe box (left); red marks on toes after wearing unsuitable shoes (right). Left: New ischaemic ulcers resulting from bullae on lateral margin of foot
Figure 7
Figure 7
Left: Ischaemic ulcer with halo of thin glassy callus. Right: The halo has been cut away without causing trauma
Figure 8
Figure 8
Left: Vacuum assisted pump sponge attached to plantar aspect of foot. Centre: Pump sponge being removed from foot. Right: Healed wound
Figure 9
Figure 9
Top (left to right): Total contact cast; Aircast prefabricated cast; Scotchcast boot. Left: A suitable shoe bought in the high street may be sufficiently roomy to avoid pressure
Figure 9
Figure 9
Top (left to right): Total contact cast; Aircast prefabricated cast; Scotchcast boot. Left: A suitable shoe bought in the high street may be sufficiently roomy to avoid pressure
Figure 9
Figure 9
Top (left to right): Total contact cast; Aircast prefabricated cast; Scotchcast boot. Left: A suitable shoe bought in the high street may be sufficiently roomy to avoid pressure
Figure 10
Figure 10
Pressure relief ankle/foot orthosis for use with heel ulcers
Figure 11
Figure 11
Left: Angiogram showing occlusion of anterior tibial artery and stenosis of tibioperoneal trunk. Right: Post-angioplasty anterior tibial flow has been restored and tibioperoneal stenosis dilated
Figure 12
Figure 12
Left: Necrotic fifth toe and necrotic apices of the first, third, and fourth toes undergoing podiatric debridement. Right: Autoamputation six weeks later, after regular debridement
Figure 13
Figure 13
Left: Increased friable granulation tissue. Right: Base of ulcer has areas of yellowish to grey tissue
Figure 14
Figure 14
Left: Deep ulcer with subcutaneous sloughing visible. Centre: Extent of debridement necessary to remove all necrotic tissue down to healthy bleeding tissue. Right: Wound has healed at 10 weeks
Figure 15
Figure 15
Left: Vein bypass seen passing across ankle to the dorsalis pedis artery. Centre: Infected ulcer with cellulitis. Right: Wet necrosis from infected toe ulcer
Figure 15
Figure 15
Left: Vein bypass seen passing across ankle to the dorsalis pedis artery. Centre: Infected ulcer with cellulitis. Right: Wet necrosis from infected toe ulcer
Figure 16
Figure 16
Left: Plantar view of infection after puncture wound that led to wet necrosis of the forefoot requiring amputation of four toes and their adjoining metatarsal heads. Right: Full healing of the large post-surgical tissue defect took six months
Figure 17
Figure 17
Oral hypoglycaemic agent found within the patient's shoe at annual review
Figure 18
Figure 18
Left: Thermal trauma from convection heater. Right: Ulceration after use of foot spa
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References

    1. Edmonds M, Foster AVM, Sanders L. A practical manual of diabetic foot care. Oxford: Blackwell Science, 2004.
    1. Bowker JH, Pfeifer MA, eds. Levin and O'Neal's the diabetic foot.6th ed. St Louis: Mosby, 2001.
    1. Boulton AJM, Connor H, Cavanagh PR, eds. The foot in diabetes.3rd ed. Chichester: Wiley, 2000.
    1. The International Working Group on the Diabetic Foot. International consensus on the diabetic foot. 2003 (www.iwgdf.org/concensus/introduction.htm)
    1. Veves A, Giurini JM, Logerfo FW, eds. The diabetic foot. Medical and surgical management. Totowa, NJ: Humana Press, 2002.