Diabetic foot disease and oedema

Abstract

Diabetic foot ulcers (DFUs) are common and disabling, giving rise to significant morbidity and mortality as well as worldwide socioeconomic problems. Despite treatment, DFUs readily become chronic wounds and may lead to major lower limb amputations. The pathogenesis of DFUs is complex and the main aetiologies are peripheral neuropathy, ischaemia from peripheral arterial disease and biomechanical abnormalities. Microvascular disease is also a significant problem for people with diabetes and contributes to foot ulceration. Successful management of DFUs consists of debridement, infection control, the use of offloading appliances and revascularisation where necessary. Foot ulcers are usually associated with infection and inflammation which lead to surrounding oedema of the foot. Standard offloading devices such as total contact casts and removable cast walkers do not actively reduce foot oedema. There is promising evidence that active oedema reduction by intermittent pneumatic compression in the diabetic foot improves ulcer healing. The objective of this article is to review the association of foot oedema and DFUs, including the role of appliances which reduce oedema. The information presented is vital to those involved in the management of DFUs.