Update on management of diabetic foot ulcers

Ann N Y Acad Sci. 2018 Jan;1411(1):153-165. doi: 10.1111/nyas.13569.


Diabetic foot ulcers (DFUs) are a serious complication of diabetes that results in significant morbidity and mortality. Mortality rates associated with the development of a DFU are estimated to be 5% in the first 12 months, and 5-year morality rates have been estimated at 42%. The standard practices in DFU management include surgical debridement, dressings to facilitate a moist wound environment and exudate control, wound off-loading, vascular assessment, and infection and glycemic control. These practices are best coordinated by a multidisciplinary diabetic foot wound clinic. Even with this comprehensive approach, there is still room for improvement in DFU outcomes. Several adjuvant therapies have been studied to reduce DFU healing times and amputation rates. We reviewed the rationale and guidelines for current standard of care practices and reviewed the evidence for the efficacy of adjuvant agents. The adjuvant therapies reviewed include the following categories: nonsurgical debridement agents, dressings and topical agents, oxygen therapies, negative pressure wound therapy, acellular bioproducts, human growth factors, energy-based therapies, and systemic therapies. Many of these agents have been found to be beneficial in improving wound healing rates, although a large proportion of the data are small, randomized controlled trials with high risks of bias.

Keywords: diabetes; diabetic foot management; diabetic foot ulcers; wound healing.

Publication types

  • Review

MeSH terms

  • Amputation, Surgical
  • Anti-Bacterial Agents / therapeutic use
  • Bandages
  • Combined Modality Therapy
  • Debridement
  • Diabetic Foot / complications
  • Diabetic Foot / drug therapy
  • Diabetic Foot / surgery
  • Diabetic Foot / therapy*
  • Humans
  • Hyperbaric Oxygenation
  • Hypoglycemic Agents / therapeutic use
  • Intercellular Signaling Peptides and Proteins / therapeutic use
  • Microbial Collagenase / therapeutic use
  • Negative-Pressure Wound Therapy
  • Patient Care Team
  • Peripheral Arterial Disease / complications
  • Physical Therapy Modalities
  • Practice Guidelines as Topic
  • Shoes
  • Skin Transplantation
  • Wound Healing
  • Wound Infection / prevention & control
  • Wound Infection / therapy


  • Anti-Bacterial Agents
  • Hypoglycemic Agents
  • Intercellular Signaling Peptides and Proteins
  • Microbial Collagenase