Foot syndrome diabetic E10.70 oder E11.70

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 27.07.2021

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DFS; diabetic foot

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Complex of pathological symptoms localised on the feet, which are directly or indirectly considered to be the consequence of diabetes mellitus, which is usually a long-term condition. The symptoms in detail: bacterial and mycotic infections, pressure-related ulcerations (see Malum perforans) and/or destruction of deep tissue areas, severe neuropathic disorders of the foot up to complex osseous destruction (see Charcot arthropathy), complicated, diabetes-induced peripheral arterial circulatory disorders of varying degrees ( PAD).

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Classification according to Wagner:
  • Risk foot, no ulceration, possibly foot deformity
  • Superficial ulceration (usually due to improper footwear; see Malum perforans below)
  • Foot deformity
  • Deep ulcer to the joint capsule, tendons or bones
  • Deep ulcer with abscess, osteomyelitis or infection of the joint capsule
  • Limited necrosis in the forefoot or heel area
  • Necrosis of the entire foot.

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4-10% of patients with diabetes mellitus suffer from DFS.

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Glycation (non-enzymatic glycosylation) leads to uncontrolled storage of glucose in numerous tissues, e.g. in vessels, nerves, connective tissue, etc..

The consequences are:

  • autonomic, motor and sensory nerve disorders (diabetogenic neuropathies)
  • Immunosuppression due to glycation of immunocompetent cells (especially macrophages, leukocytes)
  • Changes in the flow properties due to an increase in the viscosity of the blood
  • Macroangiopahies (carotid artery, large vessels of the legs: PAVK, typically below the knee).

Risk factors for diabetic foot syndrome are:

  • Long duration of diabetes:
  • High blood glucose levels
  • Hypercholesterolemia
  • Nicotine abuse
  • Presence of retinopathy, nephropathy or neuropathy
  • Decreased sensitivity
  • Callus formation due to incorrect stress (not painful or only less painful due to neuropathy)
  • Reduced muscle strength (limited stabilization of the foot)
  • Manifest leg ulcer or ulcer in the anamnesis
  • Arterial hypertension
  • Lack of exercise
  • CVI (chronic venous insufficiency with reduced joint mobility in the ankle joint - arthrogenic congestion syndrome)
  • Reduced joint mobility
  • Plantar hyperkeratosis
  • Unsuitable footwear.

Clinical features
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Initial: Warm, dry, red feet with reduced sensitivity, usually with pronounced callus formation at pressure points.

Progressive: Formation of polyneuropathic, painless ulcers on pressure-exposed areas of the foot (see below Acropathia ulcero-mutilans non-familiaris).

Late complications:

  • Infections: mycotic and bacterial infections of varying severity (erysipelas, gram-negative foot infection, foot phlegmon, necrotizing fasciitis, osteomyelitis).
  • Charcot arthropathy
  • Increasing disease-induced, enforced immobility of patients with its secondary symptoms.

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Careful inspection of the feet: neuropathic, non-painful ulcers occurring at pressure points are the typical leading symptom of diabetic foot syndrome

Specific anamnesis

Examination of touch sensitivity

Foot pulses

Ankle-arm index

If necessary, radiological diagnostics: DSA or angio-MRI.

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The therapy is based on several pillars:

  • Diabetes Optimization
  • Pressure relief
  • infection control (bacteriological monitoring, also gram-negative germs, e.g. Escherichia coli)
  • modern wound management with wound cleansing, if necessary necrosectomy
  • Consistent and situation-adapted therapy of the vascular disease.

Wound dressings with silver-activated charcoal overlays are recommended for wound treatment. Later, granulation of the wound can be promoted with a calcium-alginate dressing. Depending on the severity of the damage, minor amputations may be necessary. Education of the patient (wound and diabetes education).

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  1. Hertel T et al (2014) Diabetic foot syndrome. Skin14:190-195
  2. Cracks A (2014) The diabetic foot syndrome. Vasomed 26:191-196


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 27.07.2021