References
Assessment of the diabetic foot in inpatients
Abstract
Diabetic foot disease is a severe complication of diabetes, leading to significant morbidity and lower limb amputations. This review explores the pathophysiology of diabetic foot disease, highlighting the roles of peripheral neuropathy, peripheral arterial disease and immunosuppression in the development of foot ulcers and infections. Key intrinsic and extrinsic risk factors, including long-standing diabetes, poor glycaemic control, inappropriate footwear and trauma are discussed. The importance of comprehensive diabetic foot assessments using diagnostic tools such as the Ipswich Touch Test and Doppler studies is emphasised for early detection and management. Challenges such as delays in referral to specialist care, limited access to multidisciplinary foot teams, and staffing shortages are identified as critical barriers to effective care. The review builds upon extant literature by integrating the most recent evidence, including the 2023 guidelines from the International Working Group on the Diabetic Foot. It emphasises practical application, detailed referral pathways and multidisciplinary care strategies, offering updated tools and insights to improve clinical outcomes and address the often overlooked aspects within inpatient services. Future directions encompass advances in imaging, telemedicine and patient education, which may further optimise preventive and therapeutic strategies for diabetic foot disease.
Diabetic foot disease is a serious complication affecting individuals with diabetes, primarily resulting from a combination of peripheral neuropathy and peripheral arterial disease (PAD) (Ghirardini and Martini, 2024). These conditions lead to a loss of protective sensation, reduced blood supply, and the subsequent risk of foot ulcers, infections, and gangrene (Parise et al, 2024). Diabetic foot disease often requires hospitalisation due to its potential to cause significant morbidity and, in extreme cases, lower limb amputations (Lazzarini et al, 2024). Diabetic foot complications are a significant concern globally, with a substantial burden on healthcare systems. Approximately 19% to 34% of people with diabetes will develop a diabetic foot ulcer (DFU) in their lifetime (Centers for Disease Control and Prevention, 2024). The prevalence of these complications increases with age and the duration of diabetes, making regular foot assessments crucial (National Institute for Health and Care Excellence (NICE), 2022). In the USA, around 160 000 people with diabetes undergo amputations each year, with up to 80% being non-traumatic lower limb amputations (American Diabetes Association (ADA), 2025). According to the ADA (2025), a limb is amputated every 3 minutes and 30 seconds in the USA due to diabetes, many cases of which are preventable. Research for Public Health England (PHE) reported 27 465 amputations between 2015 and 2018, compared with 24 181 cases between 2012 and 2015 – a rise of 14% (Kerr et al, 2019). In England, 7957 major diabetic lower-limb amputations were reported between 2017/18 and 2019/20, many of which were attributable to poor diabetic control (NHS Resolution, 2022). Approximately every 30 seconds, a lower limb is amputated globally due to diabetes-related complications (Haider, 2023).
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