Diabetic foot ulcer: pathogenic and therapeutic aspects

Abstract

Introduction: Diabetic foot ulcer (DUP) is a chronic and debilitating complication associated with diabetes mellitus. It is characterized by ulcerative lesions that can progress to deep infections and even amputations. Objective: To evaluate the pathogenesis and management of diabetic foot ulcers. Methodology: This is a bibliographic review that included original articles and systematic reviews in English and Portuguese, which addressed the pathogenic and therapeutic factors associated with UPD, published between 2012 and 2024, selected from the PubMed, Scopus and SciELO databases. After careful selection, 16 articles were chosen to compose this bibliographic review. Results: A comprehensive understanding of the pathogenesis of UPD reveals that sensory and structural changes in the feet, resulting from diabetic peripheral neuropathy, make the lesions less noticeable and susceptible to damage and can lead to foot deformities, exacerbating the development or worsening of UPD. Autonomic neuropathy compromises sweating and blood circulation, increasing the risk of skin infections. Furthermore, peripheral arterial disease promotes vascular changes that increase the risk of micro and macrovascular complications. Management of UPD involves debridement, appropriate dressings, antibiotic therapy and load-relieving strategies, and arterial revascularization to promote healing and reduce the risk of amputation. Considerations: The complexity and breadth of the pathogenesis of UPD stands out, which can be characterized by three fundamental pillars: peripheral neuropathy, peripheral arterial disease and infection. Managing the condition requires comprehensive care and specialized assessment to ensure effective results. Expert assessment is essential to determine the severity of the condition, identify possible complications such as infections, and develop a personalized treatment plan for each patient.