This 2012 narrative review by Apelqvist synthesizes diagnostic and treatment evidence for diabetic foot complications — covering vascular assessment, infection diagnosis, wound healing biology, offloading, and revascularization — to address the question of how clinicians can prevent the amputations that follow untreated foot ulcers.
When you see a diabetic patient with a foot ulcer, do not wait for rest pain or claudication before ordering vascular studies — get toe pressures and tcpO2, since ABI is unreliable and most of these patients will never report classic ischemic symptoms.
When infection is suspected, debride first and diagnose depth clinically: half of deep diabetic foot infections will show no fever, normal WBC, and normal CRP, so normal labs should never falsely reassure you.
This 2012 narrative review by Apelqvist synthesizes diagnostic and treatment evidence for diabetic foot complications — covering vascular assessment, infection diagnosis, wound healing biology, offloading, and revascularization — to address the question of how clinicians can prevent the amputations that follow untreated foot ulcers.
When you see a diabetic patient with a foot ulcer, do not wait for rest pain or claudication before ordering vascular studies — get toe pressures and tcpO2, since ABI is unreliable and most of these patients will never report classic ischemic symptoms.
When infection is suspected, debride first and diagnose depth clinically: half of deep diabetic foot infections will show no fever, normal WBC, and normal CRP, so normal labs should never falsely reassure you.