Australian Diabetes Foot Network: management of diabetes-related foot ulceration — a clinical update

Shan M Bergin, Joel M Gurr, Bernard P Allard, Emma L Holland, Mark W Horsley, Maarten C Kamp, Peter A Lazzarini, Vanessa L Nube, Ashim K Sinha, Jason T Warnock, Jan B Alford and Paul R Wraight
Med J Aust 2012; 197 (4): 226-229. || doi: 10.5694/mja11.10347
  • Shan M Bergin1
  • Joel M Gurr2
  • Bernard P Allard3
  • Emma L Holland4
  • Mark W Horsley5
  • Maarten C Kamp6
  • Peter A Lazzarini7
  • Vanessa L Nube8
  • Ashim K Sinha9
  • Jason T Warnock10
  • Jan B Alford11
  • Paul R Wraight12

  • Australian Diabetes Foot Network, Australian Diabetes Society, Sydney, NSW.



The Australian Diabetes Society (ADS) receives funding from the National Diabetes Services Scheme. This guide is supported by the ADS, Australasian Podiatry Council, Australian Diabetes Educators Association, Australian and New Zealand Society for Vascular Surgery, Australian Wound Management Association and Diabetes Australia.

Competing interests:

No relevant disclosures.

  • 1. Australian Institute of Health and Welfare. Diabetes: Australian facts 2008. Canberra: AIHW, 2008. (AIHW Cat. No. CVD 40; Diabetes Series No. 8.) (accessed Apr 2011).
  • 2. Davis WA, Norman PE, Bruce DG, Davis TM. Predictors, consequences and costs of diabetes-related lower extremity amputation complicating type 2 diabetes: the Fremantle Diabetes Study. Diabetologia 2006; 49: 2634-2641.
  • 3. Reiber GE, Vileikyte L, Boyko EJ, et al. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care 1999; 22: 157-162.
  • 4. Currie CJ, Morgan C, Peters JR. The epidemiology and cost of inpatient care for peripheral vascular disease, infection, neuropathy, and ulceration in diabetes. Diabetes Care 1998; 21: 42-48.
  • 5. Calhoun JH, Overgaard KA, Stevens CM, et al. Diabetic foot ulcers and infections: current concepts. Adv Skin Wound Care 2002; 15: 31-42.
  • 6. American Diabetes Association. Consensus Development Conference on Diabetic Foot Wound Care. J Am Podiatr Med Assoc 1999; 89: 475-483.
  • 7. Australian Wound Management Association Inc. Standards for wound management. 2nd ed. AWMA, 2010. (accessed Apr 2012).
  • 8. Armstrong DG, Lavery LA, Harkless LB. Validation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to the risk of amputation. Diabetes Care 1998; 21: 855-859.
  • 9. Wagner FW Jr. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle 1981; 2: 64-122.
  • 10. Sheehan P, Jones P, Caselli A, et al. Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complex healing in a 12-week prospective trial. Diabetes Care 2003; 26: 1879-1882.
  • 11. European Wound Management Association. Wound bed preparation in practice [position document]. London: MEP Ltd, 2004. (accessed Mar 2012).
  • 12. Fisher TK, Scimeca CL, Bharara M, et al. A stepwise approach for surgical management of diabetic foot infections. J Am Podiatr Med Assoc 2010; 100: 401-405.
  • 13. Steed DL, Donohoe D, Webster MW, Lindsley L; Diabetic Ulcer Study Group. Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. J Am Coll Surg 1996; 183: 61-64.
  • 14. Edwards J, Stapley S. Debridement of diabetic foot ulcers. Cochrane Database Syst Rev 2010; (1): CD003556. doi: 10.1002/14651858.CD003556.pub2.
  • 15. Armstrong DG, Lavery LA; Diabetic Food Study Consortium. Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet 2005; 366: 1704-1710.
  • 16. Bus SA, Valk GD, van Deursen RW, et al. The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review. Diabetes Metab Res Rev 2008; 24 Suppl 1: S162-S180.
  • 17. Cavanagh PR, Bus SA. Off-loading the diabetic foot for ulcer prevention and healing. J Am Podiatr Med Assoc 2010; 100: 360-368.
  • 18. Armstrong DG, Lavery LA, Wu S, Boulton AJM. Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: a randomised controlled trial. Diabetes Care 2005; 28: 551-554.
  • 19. Frykberg RG, Bevilacqua NJ, Habershaw G. Surgical off-loading of the diabetic foot. J Am Podiatr Med Assoc 2010; 100: 369-384.
  • 20. Lipsky BA. A report from the international consensus on diagnosing and treating the infected diabetic foot. Diabetes Metab Res Rev 2004; 20 Suppl 1: S68-S77.
  • 21. Lipsky BA, Berendt AR, Deery HG, et al; Infectious Diseases Society of America. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2004; 39: 885-910.
  • 22. Antibiotic Expert Group. Therapeutic guidelines: antibiotic. Version 14. Melbourne: Therapeutic Guidelines Limited, 2010.
  • 23. Lavery LA, Armstrong DG, Peters EJ, Lipsky BA. Probe-to-bone test for diagnosing diabetic foot osteomyelitis: reliable or relic? Diabetes Care 2007; 30: 270-274.
  • 24. Berendt AR, Peters EJ, Bakker K, et al. Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment. Diabetes Metab Res Rev 2008; 24 Suppl 1: S145-S161.
  • 25. Ha Van G, Siney H, Danan JP, et al. Treatment of osteomyelitis in the diabetic foot. Contribution of conservative surgery. Diabetes Care 1996; 19: 1257-1260.
  • 26. Yadlapalli NG, Vaishnav A, Sheehan P. Conservative management of diabetic foot ulcers complicated by osteomyelitis. Wounds 2002; 14: 31-35.,0 (accessed Mar 2012).
  • 27. Ihnat DM, Mills JL Sr. Current assessment of endovascular therapy for infrainguinal arterial occlusive disease in patients with diabetes. J Am Podiatr Med Assoc 2010; 100: 424-428.
  • 28. Colagiuri S, Dickinson S, Girgis S, Colagiuri R. National evidence based guideline for blood glucose control in type 2 diabetes. Canberra: Diabetes Australia and NHMRC, 2009. (accessed May 2012).
  • 29. American Diabetes Association. Standards of medical care in diabetes — 2010. Diabetes Care 2010; 33 Suppl 1: S11-S61.
  • 30. Sumpio BE, Armstrong DG, Lavery LA, Andros G; SVS/APMA writing group. The role of interdisciplinary team approach in the management of the diabetic foot: a joint statement from the Society for Vascular Surgery and the American Podiatric Medical Association. J Vasc Surg 2010; 51: 1504-1506.
  • 31. Apelqvist J, Bakker K, van Houtum WH, Schaper NC; International Working Group on the Diabetic Foot (IWGDF) Editorial Board. Practical guidelines on the management and prevention of the diabetic foot: based upon the International Consensus on the Diabetic Foot (2007) prepared by the International Working Group on the Diabetic Foot. Diabetes Metab Res Rev 2008; 24 Suppl 1: S181–S187.
  • 32. Edmonds ME, Blundell MP, Morris ME, et al. Improved survival of the diabetic foot: the role of a specialised foot clinic. Quart J Med 1986; 60: 763-771.
  • 33. Larsson J, Apelqvist J, Agardh C, Stenström A. Decreasing incidence of major amputation in diabetic patients: a consequence of a multidisciplinary foot care team approach? Diabet Med 1995; 12: 770-776.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.