Diabetic foot

Prevention of diabetic foot may include optimising metabolic control via the regulation of blood glucose levels; identification and screening of people at high risk for diabetic foot ulceration, especially those with advanced painless neuropathy; and patient education in order to promote foot self-examination and foot care knowledge. Patients would be taught routinely to inspect their feet for hyperkeratosis, fungal infection, skin lesions and foot deformities. Control of footwear is also important as repeated trauma from tight shoes can be a triggering factor, especially where peripheral neuropathy is present. Evidence is limited that low-quality patient education courses have a long-term preventative impact. According to a 2011 meta-analysis of randomised controlled trials, only foot temperature-guided avoidance therapy was found beneficial in preventing ulceration. Prediction Monitoring a person's feet can help in predicting the likelihood of developing ulcers. A common method for this is using a special thermometer to look for spots on the foot that have higher temperature which indicate the possibility of an ulcer developing. At the same time there is no strong scientific evidence supporting the effectiveness of at-home foot temperature monitoring. The current guideline in the United Kingdom recommends collecting 8-10 pieces of information for predicting the development of foot ulcers. A simpler method proposed by researchers provides a more detailed risk score based on three pieces of information (insensitivity, foot pulse, previous history of ulcers or amputation). This method is not meant to replace people regularly checking their own feet but complement it. Once ulcers develop, the Wagner and UT scales are two methods that physicians use to determine the severity of the ulcer. These scales are the best known predictors of lower extremity amputations once ulcers develop. ==Treatment==

Treatment of diabetic foot ulceration can be challenging and prolonged; it may include orthopaedic appliances, surgery and antimicrobial drugs and topical dressings. Growth factors and cell-based therapies have been extensively investigated and applied in the treatment of diabetic foot ulcers. Most diabetic foot infections (DFIs) require treatment with systemic antibiotics. The choice of the initial antibiotic treatment depends on several factors such as the severity of the infection, whether the patient has received another antibiotic treatment for it, and whether the infection has been caused by a micro-organism that is known to be resistant to usual antibiotics (e.g. MRSA). The objective of antibiotic therapy is to stop the infection and ensure it does not spread. It is unclear whether any particular antibiotic is better than any other for curing infection or avoiding amputation. One trial suggested that ertapenem with or without vancomycin is more effective than tigecycline for resolving DFIs. It is also generally unclear whether different antibiotics are associated with more or fewer adverse effects. ==See also==