Wounds International, Vol 1; Issue 2Practice A paradigm shift is needed in diabetic foot care

A paradigm shift is needed in diabetic foot care

09/02/10 | Diabetic foot ulcers | Jan Apelqvist



In large cohort studies of patients with diabetes and foot ulcers the outcome has been measured with regard to the possibility of primary healing (healing without amputation) or of avoiding major amputation at or above the ankle [2,13]. In many studies of diabetic patients, usually about 10 to 15% (and sometimes as many as 30%) of patients not considered suitable for vascular surgery have been shown to heal without amputation or without a major amputation [2, 4].

Studies with regard to vascular intervention, on the other hand, have focused on 'limb salvage' and graft survival [6,8,14-17], indicating a need to introduce and recognise decreased perfusion or impaired circulation as an indicator for intervention in the diabetic foot to achieve healing and maintain healing and to avoid or delay a future amputation [1,2,5,13,18-20].

A new classification system is needed that recognises the various degrees of disturbed perfusion to better match appropriate treatment to individual patients – whether that be reconstructive, endovascular or pharmacological – alone or in combination.



These findings indicate a need for the recognition that a new approach and classification in neuroischaemic diabetic individuals is required, both with regard to clinical practice and science/research. New strategies must be developed and implemented for patients with a diabetic foot with decreased perfusion to improve healing, healing rate and to avoid amputation, irrespective of the intervention technology chosen. Clinicians must also recognise that a diagnosis of neuroischaemia is not only based on the presence of obstructive vascular disease.


Author details:

Jan Apelqvist, MD, PhD, Associate Professor for Diabetes and Endocrinology, University Hospital Malmo, University of Lund, Malmo, Sweden



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Page Points

  • A broader classification that recognises various degrees of disturbed perfusion is needed to better match appropriate treatment to individual patients
  • The future focus needs to be on a new approach to management and classification in patients with neuroischaemic diabetic foot ulcers