Management of the diabetic foot

The increasing prevalence of diabatic foot ulcers (DFUs) is not only costly, but carries a large mortality burden. In this article, we discuss important traditional concepts in the management of DFUs and elaborate on how new technologies have expanded our ability to treat DFUs effectively. New supplies and wound care products have been developed to target the following traditional areas of focus: tissue, infection/inflammation, moisture, and edge. Offloading strategies have grown from standard orthotics or insoles to total contact casting and three-dimensional–printed orthotics to produce the optimum material stiffness for each patient. The concepts of pressure and temperature monitoring have led to the development of multiple devices that transmit continuous monitoring in real time, giving a dynamic picture of plantar stress and training patients in new walking strategies for self-offloading. Surgical approaches have also evolved from the classic surgical debridement and correcting deformities that cause friction to creation of acellular and bio-printed cellular skin substitutes that can be used for grafting. Surveillance and long-term follow-up with a multidisciplinary team have also changed in the face of smartphones and watches that allow patients to monitor themselves in real time with daily prompts and reminders to shape desired behaviors in between clinic visits. Modern technology is changing management of DFUs by expanding on traditional concepts and improving standard therapies.