Neuropathic Diabetic Foot Ulceration

Abstract

Diabetic foot ulceration (DFU) is one of the most feared complications of diabetes; it leads to significant morbidity and confers an increased risk of lower extremity amputation. Neuropathic DFU, defined as ulceration occurring in neuropathic feet without co-existent peripheral vascular disease, is perhaps the most common type, occurring in 50–60% of DFU patients. A complex interplay between neuropathy, foot deformities, changes in plantar pressure and extrinsic factors such as footwear leading to the development of neuropathic DFU has been identified. Ulceration on the plantar foot with subtle but significant local soft tissue and bone damage are clinical hallmarks. The management of neuropathic DFU is reliant on early referral to a specialist foot clinic allowing expert assessment, wound care delivery, aggressive treatment of any infection, and importantly, appropriate offloading. Limb-threatening infections may require urgent debridement of all infected tissue. The consequent tissue defect may benefit from application of topical negative pressure wound therapy and access to early wound closure techniques. In those with significant foot deformities, surgical deformity correction may be indicated to prevent ulcer recurrence. At the same time, it is important to appreciate and treat any comorbidities that may interfere with wound healing. All patients with neuropathic DFU should receive education to improve compliance with treatment, promote ulcer healing and prevent recurrence.