Evidence based review of literature on detriments to healing of diabetic foot ulcers

Tina Lefrancois, Kinjal Mehta, Victoria Sullivan, Sheldon Lin, Mark Glazebrook

Research output: Contribution to journalReview articlepeer-review

15 Scopus citations


Background Diabetes mellitus places a substantial burden on society worldwide. Diabetic foot ulcers are a challenging problem for clinicians. Seven generally accepted detriments to healing of diabetic foot ulcers were identified: infection, glycaemic control, vascular supply, smoking, nutrition, deformity and offloading. The aim of this paper is to present a comprehensive evidence based review of the literature available on detriments to healing of diabetic foot ulcers. Method A research question was generated for each of the detriments to healing and a comprehensive review of the literature was performed using the Pubmed database in July 2014. All articles were assessed for relevancy and a level of evidence was assigned. An analysis of the total body of literature was used to assign a grade of recommendation to each detriment. Results Grade A recommendation was assigned to offloading as there was good evidence supporting this intervention. Grade B recommendation was assigned to deformity as there was fair evidence consistent with the hypothesis. Infection and vascular supply had poor quality evidence supporting the research question and grade C recommendation was assigned. Grade I recommendation was assigned to glycaemic control, smoking and nutrition as there was insufficient and conflicting evidence available. Conclusion Our literature review revealed good evidence for some factors and insufficient literature on others. Further studies are needed to provide quality evidence regarding detriments to healing of diabetic ulcers.

Original languageEnglish (US)
Pages (from-to)215-224
Number of pages10
JournalFoot and Ankle Surgery
Issue number4
StatePublished - Dec 2017
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine


  • Diabetes
  • Diabetic ulcer
  • Glycemic
  • Infection


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