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Review
. 2023 Dec 12:16:3547-3560.
doi: 10.2147/CCID.S333660. eCollection 2023.

Improving Physical, Physiological, and Psychological Health Outcomes in Patients with Diabetic Foot Ulcers - State of the Art

Prashanth Vas  1   2   3 , Nachiappan Chockalingam  2
Affiliations
Review

Improving Physical, Physiological, and Psychological Health Outcomes in Patients with Diabetic Foot Ulcers - State of the Art

Prashanth Vas et al. Clin Cosmet Investig Dermatol. .

Abstract

Diabetic foot disease is a complex and challenging complication of diabetes mellitus, which imposes a significant burden of disease on patients, their carers, and the wider health systems. Recurrence rates are high, and current evidence indicates a high mortality associated with it. While management algorithms have primarily focused on the physical aspects of healing, there is increasing recognition of the critical role played by psychological and biomechanical factors in the development and resolution of diabetic foot disease. Therefore, in this paper, we aim to explore how diabetic foot outcomes can be improved by addressing not only the physical but also the psychological and biomechanical aspects that are integral to the development of this condition and its optimal resolution. We explore new technologies that allow for non-invasive objective assessment of the diabetic foot at risk, and we also explore the role of understanding biomechanics, which is essential to determining risk of foot disease, but also the potential for recurrence. In addition, we discuss the evidence linking depression and cognitive impairment to diabetic foot disease and offer our insight on the research direction required before implementing novel information into front-line clinics.

Keywords: biomechanics; diabetic foot disease; diabetic foot ulceration; mental health and cognition; technology.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Classical neuropathic foot ulceration (A) with deformity-related ulcer on the right 1st metatarsophalangeal joint (MTPJ), more evident in (B). Note the claw toe deformities (C) and the downward subluxation of the right 1st MTPJ (D). In image (A), pressure ulceration of the left toes is also visible.
Figure 2
Figure 2
Neuroischaemic (A) showing a typical pressure area ulcer combined with lower limb features suggestive of chronic ischaemia; and Ischaemic (B) lesions on the left toes with large areas of gangrene.
Figure 3
Figure 3
Key risk factors, precipitants, and associates of suboptimal outcomes in diabetic foot ulceration. Those in yellow circles are the key drivers of diabetic foot ulcer development.
Figure 4
Figure 4
Synergy between conventional biophysical risk factors and central nervous system related factors in diabetic foot disease. a) LOPS, b) PAD and c) deformities are the most commonly encountered bio-physical risk factors of DFD.
Figure 5
Figure 5
Improving the outlook of diabetic foot management - progressing from a foot at high risk to ulceration, optimal diabetic foot ulcer care, and finally to sustaining remission. Note, a “healed” state is a transition point in care, not an endpoint of clinical efforts. Focus on maintaining “remission” is key.
Figure 6
Figure 6
Example of a thermography image of the foot. Plantar thermal image of an individual with right forefoot deformity and tight tendo-achilles with significant forefoot pressure and pre-ulcerative callus formation over the 1st and 3rd metatarsophalangeal joints. Note the significant increase in temperature which may potentially signal impending ulcer development. The circles indicate various present region of interest allowing easier identification of the most relevant areas. Caution needs to be taken while interpreting the results, especially as both hot and cooler than expected areas can also be triggered by environmental factors such as ambient temperature, the type of footwear worn etc. The cooler blue toes on the left foot in the image were related to temperature, but in the right individual may also indicate peripheral arterial disease.
See this image and copyright information in PMC

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