From the Guidelines
Diabetic foot ulcers (DFU) are often not painful due to peripheral neuropathy.
Key Points
- The presence of peripheral neuropathy can lead to an absence of pain or tenderness in diabetic foot infections [ 1 ].
- Traditional inflammatory signs of infection, such as redness, warmth, swelling, tenderness, and pain, may not be present in patients with peripheral neuropathy [ 1 ].
- The absence of pain does not rule out the presence of a diabetic foot infection, and healthcare providers should be vigilant in monitoring for other signs of infection, such as purulent secretions, friable or discolored granulation tissue, undermining of the wound edges, or a foul odor [ 1 ].
Clinical Implications
- Healthcare providers should not rely solely on patient reports of pain to diagnose diabetic foot infections.
- A thorough examination of the foot, including assessment for signs of infection and peripheral neuropathy, is essential for accurate diagnosis and treatment.
- Patients with diabetic foot ulcers should be regularly monitored for signs of infection, and prompt treatment should be initiated if infection is suspected.
From the Research
Diabetic Foot Ulcer Pain
- Diabetic foot ulcers (DFU) are considered one of the most painful complications of diabetes 2.
- The prevalence of DFU pain is significant, with 75% of patients reporting some pain related to DFU, and 57% reporting pain while walking and/or standing and during the night 3.
- DFU pain can be nociceptive and/or neuropathic in origin, and it adversely affects health-related quality of life (HRQoL) 4.
- The characteristics of DFU-related pain include tender, neuropathic, and nociceptive pain, with "tender" being the most frequently selected sensory pain descriptor 4.
Impact of DFU Pain on Health-Related Quality of Life
- Patients with DFU pain have statistically and clinically significantly poorer HRQoL than those without pain 3.
- The presence of multiple DFU locations or neuropathic pain is associated with poorer HRQoL evaluation 4.
- Sensory pain and present pain intensity are independent predictors of HRQoL in patients with DFU 4.
- DFU-related pain is prevalent and significantly impacts patients' HRQoL, highlighting the importance of prioritizing comprehensive and regular assessment of DFU-related pain during patient consultations 4.
Assessment and Treatment of DFU
- A critical triad of neuropathy, minor foot trauma, and foot deformity is found in > 63% of diabetic foot ulcers (DFU) 5.
- Peripheral vascular disease (PVD) is identified in 30% of foot ulcers 5.
- The assessment of DFU should include dermatological, vascular, neurological, and musculoskeletal systems 5.
- The basic treatments for management of DFU include debridement, antibiotics, and revascularization 5.