Understanding the multifaceted etiopathogenesis of foot complications in individuals with diabetes

Abstract

Diabetes mellitus, a chronic disease of metabolism, is characterized by a disordered production or cellular utilization of insulin. Diabetic foot disease, which comprises the spectrum of infection, ulceration, and gangrene, is one of the most severe complications of diabetes and is the most common cause of hospitalization in diabetic patients. The aim of this study is to provide an evidence-based overview of diabetic foot complications. Due to neuropathy, diabetic foot infections can occur in the form of ulcers and minor skin lesions. In patients with diabetic foot ulcers, ischemia and infection are the main causes of non-healing ulcers and amputations. Hyperglycemia compromises the immune system of individuals with diabetes, leading to persistent inflammation and delayed wound healing. In addition, the treatment of diabetic foot infections is challenging due to difficulty in accurate identification of pathogenic microorganisms and the widespread issue of antimicrobial resistance. As a further complicating factor, the warning signs and symptoms of diabetic foot problems can easily be overlooked. Issues associated with diabetic foot complications include peripheral arterial disease and osteomyelitis; accordingly, the risk of these complications in people with diabetes should be assessed annually. Although antimicrobial agents represent the mainstay of treatment for diabetic foot infections, if peripheral arterial disease is present, revascularization should be considered to prevent limb amputation. A multidisciplinary approach to the prevention, diagnosis, and treatment of diabetic patients, including those with foot ulcers, is of the utmost importance to reduce the cost of treatment and avoid major adverse consequences such as amputation.

Keywords: Diabetic foot; Diabetes mellitus; Foot ulcer; Infection; Peripheral arterial disease

Core Tip: Diabetic foot disease is a common and debilitating consequence of diabetes mellitus. Unfortunately, the recurrence rate of diabetic foot ulcers is exceptionally high, even after effective wound healing. Risk factors for foot ulcers in diabetes include peripheral neuropathy, peripheral arterial disease, mild or recurrent foot trauma, infection, foot abnormalities, history of diabetic foot ulcers or amputations, and Charcot osteoarthropathy. However, poor wound healing is thought to be the major cause of long-term diabetic wounds, while the presence of polymicrobial infections may further compound this issue. Additional studies are needed to understand the underlying mechanisms and fill the knowledge gaps that would ultimately lead to successful treatment.