Diabetic Foot Ulcer Management and Surgical Interventions

Diabetic foot ulceration represents a major complication of diabetes mellitus arising from a combination of peripheral neuropathy, vascular insufficiency and impaired wound healing. Management requires a multifaceted approach incorporating metabolic control, infection management, pressure offloading, debridement and advanced wound care modalities. Initial treatment focuses on glycaemic optimisation, identification of ulcer aetiology—neuropathic, ischaemic or neuroischaemic—and aggressive infection control with systemic antibiotics and local antimicrobial dressings. Mechanical offloading through customised footwear, orthoses or total contact casting redistributes plantar pressure to promote healing. When conservative measures prove insufficient, surgical interventions address underlying biomechanical abnormalities and enhance tissue perfusion. Minimally invasive techniques such as flexor tenotomy and metatarsal osteotomy offload focal pressure points, while larger reconstructive procedures including tendon transfers correct deformities contributing to ulceration. For ischaemic ulcers, revascularisation through endovascular angioplasty or bypass grafting restores distal perfusion. Innovative strategies such as tibial cortex transverse transport employ gradual distraction osteogenesis to stimulate angiogenesis and recruit bone marrow-derived progenitor cells, thereby enhancing microcirculation and promoting wound closure. Emerging technologies, including antibiotic-laden bone cement and growth factor-impregnated scaffolds, integrate local antimicrobial delivery with structural support. Collectively, these approaches aim to reduce healing times, minimise recurrence and prevent lower-limb amputation, underscoring the global significance of integrated medical and surgical care in diabetic foot management.

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Diabetic Foot Ulcer Management and Surgical Interventions publication trend

The graph below shows the total number of articles in diabetic foot ulcer management and surgical interventions across all publications each year (not limited to Nature Index journals).

Technical terms

Diabetic foot ulcer: A chronic wound on the foot of a patient with diabetes, typically resulting from neuropathy, ischaemia and pressure imbalance.

Offloading: Mechanical redistribution of pressure away from an ulcer site using devices such as orthoses, insoles or casts to facilitate healing.

Tibial cortex transverse transport (TTT): A surgical procedure involving controlled distraction of a tibial osteotomy segment to stimulate angiogenesis and enhance microvascular perfusion.

Endothelial progenitor cells (EPCs): Circulating stem cells that contribute to new blood vessel formation and tissue repair by homing to sites of ischaemia or injury.

Antibiotic-laden bone cement: A composite material combining polymethylmethacrylate with antibiotics to deliver high local antimicrobial concentrations while providing wound support.

References

1. Antibiotic-laden bone cement for diabetic foot infected wounds: A systematic review and meta-analysis. Frontiers in Endocrinology (2023).
2. Tibial transverse transport promotes wound healing in diabetic foot ulcers by stimulating endothelial progenitor cell mobilization and homing mediated neovascularization. Annals of Medicine (2024).
3. Efficacy of tibial cortex transverse transport in treating diabetic foot ulcer and its effect on serum omentin-1 and irisin levels. Diabetology & Metabolic Syndrome (2024).
4. The effect of flexor tenotomy on healing and prevention of neuropathic diabetic foot ulcers on the distal end of the toe. Journal of Foot and Ankle Research (2013).
5. Mini-Invasive floating metatarsal osteotomy for resistant or recurrent neuropathic plantar metatarsal head ulcers. Journal of Orthopaedic Surgery and Research (2016).