Diabetic foot

Last updated: August 21, 2023

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Summarytoggle arrow icon

Diabetic foot is a condition that results from long-standing diabetes and comprises ulcers, infections, and foot deformities. These complications result from the effects of diabetes on the peripheral nervous system and microvasculature; once one complication (e.g., ulceration) develops, the likelihood of developing another (e.g., osteomyelitis) increases. Diagnosis and management depend on the specific complication, but usually involve assessment for associated neuropathy and peripheral arterial disease (PAD), involvement of a multidisciplinary foot care team, and optimization of diabetes management. All patients should be educated on prevention of diabetic foot, e.g., daily foot examinations, foot care, and glycemic control, and encouraged to attend scheduled diabetic foot screenings.

See also “Diabetic neuropathy.”

Diabetic foot ulcerstoggle arrow icon


80% of patients with diabetes requiring a lower limb amputation had a preceding foot ulcer. [3]

Risk factors [3][4]


Diabetic foot ulcers are classified as: [3]

Neuroischemic ulcers are becoming increasingly common and now comprise half of all diabetic foot ulcers. [5]

Clinical features [2][4]


Management of diabetic foot ulcers [3]


  • Follow up with patients at 1–4 week intervals to assess healing progress. [3]
  • Patients should be followed up for life by foot care specialists (see “Prevention of diabetic foot”). [4]

Management of diabetic foot ulcers frequently requires a multidisciplinary team (e.g., podiatrist, wound care specialist, vascular surgeon, endocrinologist). [6]

Antibiotics are not indicated for diabetic ulcers unless there are signs of wound infection. [8]

Diabetic foot infectionstoggle arrow icon

Diabetic foot ulcers have a high risk of infection due to the negative effect of diabetes on immunity and microvasculature. [3]

Skin and soft tissue infections


Etiology [8]

Clinical features [8][10]

Diagnostics [8][10]

Management [3][8][10]

Patients with diabetic foot infections should receive wound care in addition to antibiotic therapy. [8]

Topical antibiotics are not indicated for the treatment of diabetic foot infections. [10]

Diabetic foot osteomyelitis [3][10]

Diabetic foot deformitiestoggle arrow icon

Diabetic neuropathy can lead to foot deformities, which increases a patient's risk of developing foot ulcers and requiring amputation. [4]

Hammer toes and claw toes [12]

See also “Toe deformities.”

Diabetic neuropathic arthropathy (Charcot foot) [14]

Diabetic neuropathic arthropathy can be challenging to distinguish from diabetic foot osteomyelitis; in diagnostic uncertainty, consider bone biopsy. [3]

Preventiontoggle arrow icon

  • Address risk factors for diabetic foot ulcers, e.g.: [3][4]
  • Educate patients (or caregivers) on: [3][4][7]
    • The importance of attending regular diabetic foot screenings
    • Daily self-monitoring, including:
    • Avoiding self-treatment of calluses/corns (e.g., chemical removal agents); patients should see a healthcare professional.
    • Selecting socks with no seams, or wearing socks with seams inside out to prevent rubbing
    • Choosing appropriate footwear
      • Avoid walking barefoot or wearing open-toed or open-heeled shoes.
      • Ensure shoes fit properly and meet the criteria for safe footwear.
      • Patients at high risk of ulceration require specialized therapeutic footwear.
    • Clinical features of diabetic foot and how to seek appropriate medical attention for them

Patients with other microvascular complications (e.g., diabetic retinopathy, peripheral neuropathy) may struggle to perform daily foot care; teach caregivers to examine the foot if there are concerns about the patient's ability to self-monitor. [4]

Screening for diabetic foot [3][4][7]

Referencestoggle arrow icon

  1. $Contributor Disclosures - Diabetic foot. All of the relevant financial relationships listed for the following individuals have been mitigated: Alexandra Willis (copyeditor, was previously employed by OPEN Health Communications). None of the other individuals in control of the content for this article reported relevant financial relationships with ineligible companies. For details, please review our full conflict of interest (COI) policy:.
  2. Hingorani A, LaMuraglia GM, Henke P, et al. The management of diabetic foot: A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. J Vasc Surg. 2016; 63 (2): p.3S-21S.doi: 10.1016/j.jvs.2015.10.003 . | Open in Read by QxMD
  3. Nuha A. ElSayed, Grazia Aleppo, Vanita R. Aroda, Raveendhara R. Bannuru, Florence M. Brown, et al.. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes 2023. Diabetes Care. 2022; 46 (Supplement_1): p.S203-S215.doi: 10.2337/dc23-s012 . | Open in Read by QxMD
  4. Bus SA, Lavery LA, Monteiro‐Soares M, et al. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020; 36 (S1).doi: 10.1002/dmrr.3269 . | Open in Read by QxMD
  5. Senneville É, Lipsky BA, Abbas ZG, et al. Diagnosis of infection in the foot in diabetes: a systematic review. Diabetes Metab Res Rev. 2020; 36 (S1).doi: 10.1002/dmrr.3281 . | Open in Read by QxMD
  6. Lipsky et al. 2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections. Clin Infect Dis. 2012; 54 (12): p.e132-e173.doi: 10.1093/cid/cis346 . | Open in Read by QxMD
  7. Lipsky BA, Senneville É, Abbas ZG, et al. Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020; 36 (S1).doi: 10.1002/dmrr.3280 . | Open in Read by QxMD
  8. Bader MS. Diabetic foot infection. Am Fam Physician. 2008; 78 (1): p.71-9.
  9. Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017; 376 (24): p.2367-2375.doi: 10.1056/nejmra1615439 . | Open in Read by QxMD
  10. Armstrong DG, Cohen K, Courric S, Bharara M, Marston W. Diabetic Foot Ulcers and Vascular Insufficiency: Our Population Has Changed, but Our Methods Have Not. J Diabetes Sci Technol. 2011; 5 (6): p.1591-1595.doi: 10.1177/193229681100500636 . | Open in Read by QxMD
  11. Schaper NC, Netten JJ, Apelqvist J, et al. Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev. 2020; 36 (S1).doi: 10.1002/dmrr.3266 . | Open in Read by QxMD
  12. Doty JF, Fogleman JA. Treatment of Rigid Hammer-Toe Deformity. Foot Ankle Clin. 2018; 23 (1): p.91-101.doi: 10.1016/j.fcl.2017.09.007 . | Open in Read by QxMD
  13. Kimura T, Thorhauer ED, Kindig MW, Shofer JB, Sangeorzan BJ, Ledoux WR. Neuropathy, claw toes, intrinsic muscle volume, and plantar aponeurosis thickness in diabetic feet. BMC Musculoskelet Disord. 2020; 21 (1).doi: 10.1186/s12891-020-03503-y . | Open in Read by QxMD
  14. Rogers LC, Frykberg RG, Armstrong DG, et al. The Charcot Foot in Diabetes. Diabetes Care. 2011; 34 (9): p.2123-2129.doi: 10.2337/dc11-0844 . | Open in Read by QxMD

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