Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Dec 15, 2022; 13(12): 1049-1065
Published online Dec 15, 2022. doi: 10.4239/wjd.v13.i12.1049
Diabetic foot ulcers: Classification, risk factors and management
Xuan Wang, Chong-Xi Yuan, Bin Xu, Zhi Yu
Xuan Wang, Chong-Xi Yuan, Bin Xu, Zhi Yu, Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
Author contributions: All the authors contributed to the initial writing and have read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81873238 and 82074532; the Open Projects of the Discipline of Chinese Medicine of Nanjing University of Chinese Medicine supported by the Subject of Academic Priority Discipline of Jiangsu Higher Education Institutions, No. ZYX03KF012; and the Postgraduate Research & Practice Innovation Program of Jiangsu Province, No. KYCX22_1963.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Zhi Yu, PhD, Lecturer, Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, No. 138 Xianlin Road, Nanjing 210023, Jiangsu Province, China.
Received: August 27, 2022
Peer-review started: August 27, 2022
First decision: October 5, 2022
Revised: October 18, 2022
Accepted: November 18, 2022
Article in press: November 18, 2022
Published online: December 15, 2022

Diabetic foot ulceration is a devastating complication of diabetes that is associated with infection, amputation, and death, and is affecting increasing numbers of patients with diabetes mellitus. The pathogenesis of foot ulcers is complex, and different factors play major roles in different stages. The refractory nature of foot ulcer is reflected in that even after healing there is still a high recurrence rate and amputation rate, which means that management and nursing plans need to be considered carefully. The importance of establishment of measures for prevention and management of DFU has been emphasized. Therefore, a validated and appropriate DFU classification matching the progression is necessary for clinical diagnosis and management. In the first part of this review, we list several commonly used classification systems and describe their application conditions, scope, strengths, and limitations; in the second part, we briefly introduce the common risk factors for DFU, such as neuropathy, peripheral artery disease, foot deformities, diabetes complications, and obesity. Focusing on the relationship between the risk factors and DFU progression may facilitate prevention and timely management; in the last part, we emphasize the importance of preventive education, characterize several of the most frequently used management approaches, including glycemic control, exercise, offloading, and infection control, and call for taking into account and weighing the quality of life during the formulation of treatment plans. Multidisciplinary intervention and management of diabetic foot ulcers (DFUs) based on the effective and systematic combination of these three components will contribute to the prevention and treatment of DFUs, and improve their prognosis.

Keywords: Diabetes, Diabetes foot ulceration, Classification, Diabetes complications, Clinical management, Lower limb complications

Core Tip: Diabetic foot ulcers (DFUs) are a common complication of diabetes. The high recurrence and amputation rates associated with DFUs reflect an urgent need to improve care and treatment methods, highlighting the importance of a comprehensive investigation of the important components of clinical diagnosis and treatment. This article reviews the classification and risk factors of DFUs and summarizes the common clinical management approaches.