Inpatient management of diabetic foot disorders: a clinical guide Journal Article

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Authors: Wukich, D. K.; Armstrong, D. G.; Attinger, C. E.; Boulton, A. J.; Burns, P. R.; Frykberg, R. G.; Hellman, R.; Kim, P. J.; Lipsky, B. A.; Pile, J. C.; Pinzur, M. S.; Siminerio, L.
Article Title: Inpatient management of diabetic foot disorders: a clinical guide
Abstract: The implementation of an inpatient diabetic foot service should be the goal of all institutions that care for patients with diabetes. The objectives of this team are to prevent problems in patients while hospitalized, provide curative measures for patients admitted with diabetic foot disorders, and optimize the transition from inpatient to outpatient care. Essential skills that are required for an inpatient team include the ability to stage a foot wound, assess for peripheral vascular disease, neuropathy, wound infection, and the need for debridement; appropriately culture a wound and select antibiotic therapy; provide, directly or indirectly, for optimal metabolic control; and implement effective discharge planning to prevent a recurrence. Diabetic foot ulcers may be present in patients who are admitted for nonfoot problems, and these ulcers should be evaluated by the diabetic foot team during the hospitalization. Pathways should be in place for urgent or emergent treatment of diabetic foot infections and neuropathic fractures/dislocations. Surgeons involved with these patients should have knowledge and interest in limb preservation techniques. Prevention of iatrogenic foot complications, such as pressure sores of the heel, should be a priority in patients with diabetes who are admitted for any reason: all hospitalized diabetic patients require a clinical foot exam on admission to identify risk factors such as loss of sensation or ischemia. Appropriate posthospitalization monitoring to reduce the risk of reulceration and infection should be available, which should include optimal glycemic control and correction of any fluid and electrolyte disturbances.
Journal Title: Diabetes care
Volume: 36
Issue: 9
ISSN: 1935-5548; 0149-5992
Publisher: Unknown  
Journal Place: United States
Date Published: 2013
Start Page: 2862
End Page: 2871
Language: eng
DOI/URL:

10.2337/dc12-2712
Notes: LR: 20141112; GR: UL1 TR000005/TR/NCATS NIH HHS/United States; JID: 7805975; OID: NLM: PMC3747877; ppublish