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Neuropathy, ulceration, infection and Charcot — structured limb-salvage pathway
Diabetic foot disease affects up to 25% of people with diabetes during their lifetime and is the leading cause of non-traumatic lower-limb amputation. At Dr. Bodh Raj’s clinic, diabetic foot management follows a structured limb-salvage pathway: risk stratification (monofilament testing, vibration sense, ankle-brachial index), wound classification (Wagner or University of Texas system), infection control (IDSA/IWGDF criteria), offloading, vascular assessment, and multidisciplinary coordination with endocrinology, vascular surgery, and podiatry.
Kathmandu Neurology Clinic & Cognitive Center
Authored and reviewed by Dr. Bodh Raj Gautam (MBBS (KU), MS-Orthopedics (GMC), Cert. Podiatry & Diabetic Foot (India), NMC 23071). Evidence-based, no fabricated outcomes.
Diabetic foot disease affects up to 25% of people with diabetes during their lifetime and is the leading cause of non-traumatic lower-limb amputation. At Dr. Bodh Raj’s clinic, diabetic foot management follows a structured limb-salvage pathway: risk stratification (monofilament testing, vibration sense, ankle-brachial index), wound classification (Wagner or University of Texas system), infection control (IDSA/IWGDF criteria), offloading, vascular assessment, and multidisciplinary coordination with endocrinology, vascular surgery, and podiatry.
Reviewed by Dr. Bodh Raj Gautam, MBBS, MS-Orthopedics — Consultant Orthopedic Surgeon & Foot Nail Specialist (NMC 23071), Kathmandu Neurology Clinic. For evaluation, book an appointment.
Diabetic foot pathology arises from the convergence of peripheral neuropathy (loss of protective sensation), peripheral arterial disease (ischaemia), and immunopathy (impaired wound healing and infection resistance). The insensate foot develops callus over pressure points, which ulcerates, becomes infected, and may progress to osteomyelitis and gangrene if not identified early. Charcot neuroarthropathy — acute joint destruction in a neuropathic foot — is a limb-threatening emergency that must be differentiated from infection or simple sprain.
Management begins with risk stratification and patient education on daily foot inspection, appropriate footwear, and when to seek emergency care. Active ulcers are treated with wound bed preparation (debridement, moisture balance, infection control), offloading (total contact casting or irremovable walkers), and vascular assessment when perfusion is inadequate. Infection is managed with the IDSA/IWGDF framework: mild (oral antibiotics), moderate (IV antibiotics plus surgical debridement), severe (urgent surgical drainage and possible amputation). Charcot is treated with immediate immobilization and extended non-weight-bearing.
Guidelines referenced:
Lavery LA et al. IWGDF guidelines on the prevention and management of diabetic foot disease. Diabetes CareLipsky BA et al. IDSA guideline on diabetic foot infections. Clin Infect DisNICE NG19 — Diabetic foot problems: prevention and managementContent on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.