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Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Differentiating Diabetic foot from other diseases

Introduction

Overview

Overview

Diabetic foot must be differentiated from other diseases that cause foot ulceration, erythema, swelling and skin lesion, such as skin and soft-tissue infections, gas gangrene, cellulitis, deep venous thrombosis and inflammatory disorders.

Differentiating Diabetic foot from other Diseases

Differentiating Diabetic foot from other Diseases

Diseases Symptoms Signs Gold standard Investigation to diagnose
History Onset Pain Fever Laterality Scrotal swelling Symptoms of primary disease
Diabetic foot *History of poor glycemic control
*Trauma
*Burn 		Chronic + – + – Unilateral – Since it is related to diabetes, symptoms such as polyuria, polydipsia and polyphagia could be seen. *Shiny skin
*Decreased hair distribution
*Ulcer
*Signs of infection
*Foot deformities such as charcot foot and hammer toe 		The diagnosis of diabetic foot could be done by clinical findings, nevertheless MRI is essential to exclude the osteomyelitis.
(Cellulitis-erysipelas-skin abscess) Acute + + Unilateral – –
  • Usually it doesn’t need any laboratory tests to diagnose.[5]
  • Blood cultures are warranted for patients in the following circumstances:[6]
  1. Systemic toxicity
  2. Extensive skin or soft tissue involvement
  3. Underlying comorbidities
  4. persistent cellulitis
Lymphatic filariasis
  • History of living in endemic area or travelling to it
 Chronic + + Bilateral + –

Preparing blood smears

  • Thick smears
  1. Thick smears consist of a thick layer of dehemoglobinized (lysed) red blood cells (RBCs).
  2. Thick smears allow a more efficient detection of parasites (increased sensitivity).
  • Thin smears consist of blood spread in a layer such that the thickness decrease.

By the ultrasound, the following findings can be observed:

  • Dilated lymphatic channels
  • Living worms tend to be in motion which called “filarial dance” sign.
Chronic venous insufficiency Chronic + – Bilateral +

(If congenial)

–
  • Typical varicose veins
  • Skin change distribution correlate with varicose veins sites in the medial side of ankle and leg
  • Reduction of swelling with limb elevation.
Acute deep venous thrombosis Acute + – Unilateral – May be associated with primary disease mandates recumbency for long duration
Lipedema Chronic + – Bilateral – –
  • Tender with palpation
  • Negative Semmer sign to differentiate from lymphedema.[10]
  • Pinching the skin on the upper surface of the toes. If it is possible to grasp a thin fold of tissue then it is negative result.
  • In a positive result, it is only possible to grasp a lump of tissue.
  • MRI offers strong qualitative and quantitative parameters in the diagnosis of lipedema [11]
Myxedema Chronic + – Bilateral – +

(hypothyroidism )

Other causes of generalized edema
  • History of chronic general condition (cardiac-liver-renal)
 Chronic – – Bilateral – +
  • According to the primary cause ( Echo- LFTs– RFT)
References

References

  1. ↑ Hess CT (2010). “Checklist for differential diagnosis of lower-extremity ulcers”. Adv Skin Wound Care. 23 (10): 480. doi:10.1097/01.ASW.0000383230.16279.b0. PMID 20859079.
  2. ↑ Pendsey SP (2010). “Understanding diabetic foot”. Int J Diabetes Dev Ctries. 30 (2): 75–9. doi:10.4103/0973-3930.62596. PMC 2878694. PMID 20535310.
  3. ↑ Boulton AJM, Armstrong DG, Kirsner RS, Attinger CE, Lavery LA, Lipsky BA; et al. (2018). “Diagnosis and Management of Diabetic Foot Complications”. doi:10.2337/db20182-1. PMID 30958663.
  4. ↑ Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). “Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America”. Clin Infect Dis. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.
  5. ↑ Raff AB, Kroshinsky D (2016). “Cellulitis: A Review”. JAMA. 316 (3): 325–37. doi:10.1001/jama.2016.8825. PMID 27434444.
  6. ↑ Woo PC, Lum PN, Wong SS, Cheng VC, Yuen KY (2000). “Cellulitis complicating lymphoedema”. Eur J Clin Microbiol Infect Dis. 19 (4): 294–7. PMID 10834819.
  7. ↑ Leppard BJ, Seal DV, Colman G, Hallas G (1985). “The value of bacteriology and serology in the diagnosis of cellulitis and erysipelas”. Br J Dermatol. 112 (5): 559–67. PMID 4005155.
  8. ↑ Goodacre S, Sutton AJ, Sampson FC (2005). “Meta-analysis: The value of clinical assessment in the diagnosis of deep venous thrombosis”. Ann Intern Med. 143 (2): 129–39. PMID 16027455. Review in: ACP J Club. 2006 Mar-Apr;144(2):46-7 Review in: Evid Based Med. 2006 Apr;11(2):56
  9. ↑ Child AH, Gordon KD, Sharpe P, Brice G, Ostergaard P, Jeffery S; et al. (2010). “Lipedema: an inherited condition”. Am J Med Genet A. 152A (4): 970–6. doi:10.1002/ajmg.a.33313. PMID 20358611.
  10. ↑ Trayes KP, Studdiford JS, Pickle S, Tully AS (2013). “Edema: diagnosis and management”. Am Fam Physician. 88 (2): 102–10. PMID 23939641.
  11. ↑ Dimakakos PB, Stefanopoulos T, Antoniades P, Antoniou A, Gouliamos A, Rizos D (1997). “MRI and ultrasonographic findings in the investigation of lymphedema and lipedema”. Int Surg. 82 (4): 411–6. PMID 9412843.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]