SAP Podiatry
From ulcer to remission: podiatric and technological strategies to prevent ulceration and amputation in the diabetic foot
By Maikro Osvaldo Chávez Moya, Leodanis Hernández Cabrera, Lauren Martínez Ramírez and 4 others.
Abstract
Introduction
diabetic foot ulcers precede most diabetes-related amputations and recur frequently, so prevention is as important as treatment.
Objective
to synthesise the evidence on preventing ulceration and amputation in the diabetic foot: risk stratification, footwear and offloading, temperature monitoring, podiatric and integrated care, and the situation in Latin America.
Methods
narrative review based on a non-systematic search of guidelines, systematic reviews, randomised trials, cohort studies and regional publications, with a qualitative synthesis in five areas. Development: foot ulcers affect roughly 18.6 million people yearly, recurring in 42% at one year and 65% at five. In a meta-analysis of five randomised trials, home temperature monitoring was associated with lower ulceration risk (RR 0.51), although the largest trial showed no significant reduction in its primary outcome. Pressure-optimised footwear and structured education also appear useful, with wide confidence intervals. Non-removable knee-high offloading is first choice for neuropathic plantar ulcers, and about half of affected people have peripheral artery disease. Podiatric care before ulceration was associated with lower risk of amputation or death in dialysis patients (HR 0.89). Latin American data are scarce: in Argentina, only 3 in 10 people with diabetes had a foot examination in the previous year.