Diabetic foot historical perspective

The discovery of the association between diabetes and foot ulceration and subsequent infection dates back to the 1850s. Significant breakthroughs in the management of diabetic foot wounds include the introduction of surgical debridement occurred in the early 1900s by Frederick Treves. He also introduced the critical role of footwear in diabetic foot ulcers. Furthermore the discovery of penicillin in 1928 by Alexander Fleming reduced the mortality rate of diabetic foot patients and their related complications significantly. Throughout the 20th century, advances in surgical limb revascularization and the advent of angioplasty drastically reduced the need for amputation. The latter method remained the mainstays of diabetic foot management, in the 2004 and 2012 Infectious Disease Society of America guidelines.

• Marchal de Calvi and Thomas Hodgkin first identified an association between diabetes and foot ulceration and potential infection of that, as a significant source of morbidity and mortality among these patients, in 1850s. All skin ulcers at that time were treated with prolonged bedrest, however these lesions didn’t response to immobilization.^[1][2]
• At the turn of the 19th century, Frederick Treves introduced surgical debridement of diabetic wounds as well as modified footwear in order to distribute pressure more evenly across the heal.^[2]
• A significant breakthrough occurred in 1928, when a Scottish scientist, Alexander Fleming discovered penicillin, which further reduced mortality and morbidity (such as major amputation) from diabetic foot infections by nearly 50%.^[1][2]
• Throughout the 20th century, advances in surgical limb revascularization and the advent of angioplasty drastically reduced the need for amputation and remained a mainstay of treatment.^[3][4]
• In 2004, the Infectious Disease Society of America published initial clinical practice guideline for the diagnosis and treatment of diabetic foot infection and with recent updates in 2012, provide an up-to-date diagnostic and therapeutic information to clinicians.^[5]