Diabetic foot disease has a significant global burden on patients and medical care systems. Since 1999, the International Working Group of Diabetic Football (IWGDF) has been formulating a guide to preventing and managing diabetes on the basis of evidence. In 2019, IWGDF updated multiple relevant guidelines. Today, I compiled the diabetes foot prevention and management guidelines. This guide is divided into several parts for your reference.
Prevention of ulcers of diabetic foot
There are five key factors related to foot ulcer prevention:
(1) Identify the risky feet.
(2) Regular inspections of high -risk football: For example, the figure below shows the high incidence of high incidence of foot ulcers.
(3) Education of patients, family members and medical care professionals: For example, how to improve the knowledge of patients’ self -care and self -protection behavior, such as how to properly cut toenails (Figure 2), the church patients discover problems in time and make problems Correct measures.
(4) Ensure the appropriate shoes daily: For example, to ensure that the shoes are large enough to avoid excessive skin pressure on the foot.
(5) Risk factor for treating ulcers.
Evaluation and classification of foot ulcers
We should follow standardized and consistent strategies to evaluate foot ulcers, because this will guide further evaluation and treatment, and the following problems should be solved.
1. Type
Through medical history and clinical examination, ulcers are divided into neuroma, neuropathy or ischemia. Loss of protection (LOPS) is a characteristic of neurochemical ulcers. The first step needs to ask patients’ medical history and touch foot arteries to screen for whether there are peripheral arterial diseases (PADs). Patients with diabetic foot ulcers have no specific symptoms or signs. Therefore, the Doppler arteries of the ankle or foot are used to measure the PAD by measuring bilateral ankle systolic blood pressure and bilateral ankle brachial index (ABI).
When the ABI index is between 0.9-1.3 or the hoeing of the foot of the foot, and the toe babed index (TBI) ≥0.75 can exclude most PADs. However, due to the calcification of foot arteries, the ankle pressure and the ABI index may be increased. Under certain circumstances, other tests can be selected, such as measuring toe pressure or cross -corticoxyllet pressure (TCPO2), which can be used to evaluate the blood vessel status of the foot.
2. Cause
Walking with inappropriate shoes and barefoot often leads to foot ulcers, and even among patients with ischemic ulcers. Therefore, every patient with diabetic foot ulcers needs to check shoes and socks carefully.
3. Site and depth
Neurocar ulcers often occur on the soles of the foot or areas of the foot of the foot. Ischemia and neuropathy is more common in the side of the toes or feet.
Determining the depth of foot ulcers is more difficult, especially the ulcers that exist in necrotic tissue or below the cricket. To help evaluate ulcers, any neuro or neuropathy ischemia ulcers need to be cleared and necrotic tissue before assessment. However, do not know the infected ulcers with severe ischemia. Neurocar ulcers are usually debrided without local anesthesia.
4. Signs of infection
The feet infection of diabetic patients pose a serious threat to the affected feet and limbs, and must be evaluated and treated in a timely manner. There are at least two types of inflammation or symptoms (redness, increased skin temperature, intensity, pain/tenderness) or purulent secretions. Unfortunately, these symptoms may be weakened under neurological or local ischemia, and mild to moderate infections may lack systemic symptoms (such as pain, fever, and leukocytes).
The IDSA / IWGDF grading method should be used to classify the infection: mild infection (the minimum honeycomb wovenitis), moderate (deeper or wider infection) or severe (systemic symptoms with sepsis), whether they are accompanied osteomyelitis.
If the treatment is improper, the infection can continue to spread to the tissue below, including bone (osteomyelitis). Therefore, patients with diabetic foot infections need to have bone marrowitis, especially for ulcers on long, deep or directly located on protruding bones. In this case, a sterile metal probe can be detected. In addition, X -flat tablets, magnetic resonance, radioactive nucleoin, or PET scan can assist the diagnosis.
For infected wounds, the tissue samples used for cultivation (if the conditions are allowed to be painted with Gram -dyeing); avoid using cotton swabs to obtain wound culture specimens. The pathogens (and its antibiotic sensitivity) of the foot infection vary from geographical location, population scientific data and clinical conditions, but in most cases, Staphylococcus aureus (separate infection or other infections) is the main pathogen body. Essence Chronic and severe infections are usually a variety of microorganisms. The Gram -negative bacteria are accompanied by Gram -positive bacteria and anaerobic bacteria, especially in a warmer climate environment.
5. Other related factors
In addition to systematically evaluating ulcers, feet and legs, other factors of patients must also be considered, such as end -end renal diseases, edema, malnutrition, anemia, poor metabolism, or psychological and social problems.
Principles of ulcer treatment
The ulcers are treated according to the following principles. Generally, the ulcers of most patients can be cured. Even if the wound care is better, if it does not solve the problem of ischemia or infection well, it is not conducive to trauma healing. For deeper ulcers, strengthen treatment may require hospitalization. Below is the basic principle of ulcer treatment.
(1) Decompression and protection of ulcers: pressure decompression is the basic principle of ulcers caused by increased biomechanical pressure.(2) Restore tissue irrigation.
(3) Processing infection.For details, please refer to: IWGDF Guide: diagnosis and treatment of diabetic foot infection
(4) Metabolic control and treatment of common diseases.
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(5) Care for local ulcers.For details, please refer to: 16 recommendations for diabetic foot ulcer prevention prevention
(6) Provide related education for patients and relatives.
