Research Topic

Understanding Diabetic Foot Disease: Current Status and Emerging Treatment Approaches

About this Research Topic

Diabetic foot disease is one of the most common and dreadful complications of diabetes. People with diabetes have up to 34% lifetime risk of developing diabetic foot ulcers, while foot wounds precede around 80% of all diabetes-related lower extremity amputations. Unfortunately, even after successful wound healing, the recurrence rates of diabetic foot ulcers reach up to 40% within a year.

Diabetic foot ulcers commonly occur by minor or repetitive trauma on an area of the foot in a person with diabetic peripheral neuropathy and/or peripheral arterial disease. Foot deformities and reduced joint mobility leading to aberrant biomechanical loading of the foot can also play a notable role. The pathophysiology of diabetic wound healing is multifaceted but not completely understood, and impaired wound healing is the eminent cause leading to chronic open wounds in diabetes. More than half of diabetic open wounds become infected, which further slows ulcer healing and increases the risk of foot amputation.

Despite recent advances in understanding the aetiology and pathophysiology of diabetic foot wounds, their management is remarkably challenging for health care providers. Current guidelines recommend a standard of care that includes off-loading, wound debridement and wound dressings for moisture balance of the ulcer, management of peripheral arterial disease, and management of infection. Nevertheless, the outcomes are rather unsatisfactory and only around 70% of diabetic foot ulcers heal after one year, while most recommendations are not based on high quality evidence. Patient’s non-adherence to treatment and especially off-loading is considered a major factor affecting the clinical outcome, whereas the impact of surgical treatment on diabetic foot disease is not clear yet. Alternative more advanced treatment modalities should be considered after all standard of care has been implemented for 4 weeks and a 50% reduction in ulcer size has not been achieved. Nevertheless, no official recommendation for the choice of treatment is available to date due to limited clinical experience and low-quality data.

Further research is warranted in order to understand the underlying mechanisms of diabetic foot disease and to fill the gaps of knowledge relating to successful management. The complexity of diabetic foot syndrome demands a multidisciplinary approach including both emergency treatment of acute foot attack and holistic continuing care of the patient and the wound.

This Research Topic will provide an update of the factors implicated in the pathophysiology of diabetic foot disease, as well as new insights in the multidisciplinary management of all aspects of diabetic foot syndrome. Evidence-based health care calls for high quality data for the implementation of treatment based on the underlying causative factors and the pathophysiological irregularities that contribute to the development of diabetic foot disease.

This Research Topic welcomes original research articles, reviews, short communications, and commentaries on epidemiology, pathophysiology, management, clinical trials or observational studies, and impact on the health care system of diabetic foot syndrome. Themes of interest include, but are not limited, to the following:

• Epidemiology of diabetic foot disease, mortality
• Risk factors, pathophysiology and prevention of diabetic foot ulceration
• Pathophysiology, diagnosis and management of charcot foot
• Diagnosis and management of peripheral arterial disease
• Pathophysiology, diagnosis and management of diabetic neuropathy
• Epidemiology, molecular mechanisms, microbiome and management of diabetic foot ulcer infections
• Future therapeutic adjuncts


*Topic Editor Prof. Tentolouris has received research grant from TRIGIcare International GmbH, Wiehl-Drabenderhöhe, Germany. The other Topic Editors declare no competing interests with regards to the Research Topic theme.


Keywords: Diabetic foot ulcers, peripheral arterial disease, diabetic neuropathy, wound healing, charcot foot, diabetic foot infections, amputations


Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

Diabetic foot disease is one of the most common and dreadful complications of diabetes. People with diabetes have up to 34% lifetime risk of developing diabetic foot ulcers, while foot wounds precede around 80% of all diabetes-related lower extremity amputations. Unfortunately, even after successful wound healing, the recurrence rates of diabetic foot ulcers reach up to 40% within a year.

Diabetic foot ulcers commonly occur by minor or repetitive trauma on an area of the foot in a person with diabetic peripheral neuropathy and/or peripheral arterial disease. Foot deformities and reduced joint mobility leading to aberrant biomechanical loading of the foot can also play a notable role. The pathophysiology of diabetic wound healing is multifaceted but not completely understood, and impaired wound healing is the eminent cause leading to chronic open wounds in diabetes. More than half of diabetic open wounds become infected, which further slows ulcer healing and increases the risk of foot amputation.

Despite recent advances in understanding the aetiology and pathophysiology of diabetic foot wounds, their management is remarkably challenging for health care providers. Current guidelines recommend a standard of care that includes off-loading, wound debridement and wound dressings for moisture balance of the ulcer, management of peripheral arterial disease, and management of infection. Nevertheless, the outcomes are rather unsatisfactory and only around 70% of diabetic foot ulcers heal after one year, while most recommendations are not based on high quality evidence. Patient’s non-adherence to treatment and especially off-loading is considered a major factor affecting the clinical outcome, whereas the impact of surgical treatment on diabetic foot disease is not clear yet. Alternative more advanced treatment modalities should be considered after all standard of care has been implemented for 4 weeks and a 50% reduction in ulcer size has not been achieved. Nevertheless, no official recommendation for the choice of treatment is available to date due to limited clinical experience and low-quality data.

Further research is warranted in order to understand the underlying mechanisms of diabetic foot disease and to fill the gaps of knowledge relating to successful management. The complexity of diabetic foot syndrome demands a multidisciplinary approach including both emergency treatment of acute foot attack and holistic continuing care of the patient and the wound.

This Research Topic will provide an update of the factors implicated in the pathophysiology of diabetic foot disease, as well as new insights in the multidisciplinary management of all aspects of diabetic foot syndrome. Evidence-based health care calls for high quality data for the implementation of treatment based on the underlying causative factors and the pathophysiological irregularities that contribute to the development of diabetic foot disease.

This Research Topic welcomes original research articles, reviews, short communications, and commentaries on epidemiology, pathophysiology, management, clinical trials or observational studies, and impact on the health care system of diabetic foot syndrome. Themes of interest include, but are not limited, to the following:

• Epidemiology of diabetic foot disease, mortality
• Risk factors, pathophysiology and prevention of diabetic foot ulceration
• Pathophysiology, diagnosis and management of charcot foot
• Diagnosis and management of peripheral arterial disease
• Pathophysiology, diagnosis and management of diabetic neuropathy
• Epidemiology, molecular mechanisms, microbiome and management of diabetic foot ulcer infections
• Future therapeutic adjuncts


*Topic Editor Prof. Tentolouris has received research grant from TRIGIcare International GmbH, Wiehl-Drabenderhöhe, Germany. The other Topic Editors declare no competing interests with regards to the Research Topic theme.


Keywords: Diabetic foot ulcers, peripheral arterial disease, diabetic neuropathy, wound healing, charcot foot, diabetic foot infections, amputations


Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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Submission Deadlines

30 September 2020 Manuscript

Participating Journals

Manuscripts can be submitted to this Research Topic via the following journals:

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Topic Editors

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Submission Deadlines

30 September 2020 Manuscript

Participating Journals

Manuscripts can be submitted to this Research Topic via the following journals:

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