DOI: 10.25881/20728255_2023_18_2_115


Yesipov A.V.1, 3, Alekhnovich A.V.1, Musailov V.A.2, 3, Markevich P.S.1, Potapov V.A.3

1 National Medical Research Center for High Medical Technologies — Central Military Clinical Hospital named after A.A. Vishnevsky, Moscow region

2 Branch №1 of the National Medical Research Center for High Medical Technologies — Central Military Clinical Hospital named after A.A. Vishnevsky, Moscow region

3 Branch of S.M. Kirov Military medical academy, Moscow


There is a constant increase in the prevalence of diabetes mellitus all over the world. According to the Federal Register of Patients with Diabetes Mellitus, more than 200 thousand new cases of diabetes mellitus are registered in the Russian Federation per year. As a result, the number of patients with such a complication as diabetic foot syndrome is also increasing. With type 1 diabetes, diabetic foot syndrome is registered in 4.3% of patients, with type 2 diabetes — in 2.0%. The results of treatment of purulent-destructive complications of diabetic foot still do not satisfy surgeons, a large percentage of high amputations remains, reaching 30.0–50.0%.

For diagnostic purposes, ultrasound Dopplerography of the arteries of the lower extremities, duplex scanning with color mapping, and, if necessary, radiopaque angiography of the arteries of the lower extremities are used. Also included in the complex of diagnostics of diabetic foot syndrome are rheolymphovasography with an assessment of the rate and volume of flowing peripheral lymph and blood, impedance measurement, thermal imaging, chronaximetric electrodiagnostics, laser Doppler flowmetry.

The article is a review of the literature, the task of which is to highlight the continuing difficulties of timely diagnosis in the treatment of diabetes mellitus and diabetic foot syndrome, despite years of close attention to this problem.

Keywords: diabetes mellitus, diabetic foot syndrome, amputations, angiopathy, ultrasound dopplerography, angiography.


1. Dedov II, Shestakova MV, Mayorov AYu, et al. Algorithms for specialized medical care for with diabetes mellitus. Saharnyj diabet. 2019; 22: 1-144. (In Russ.)

2. Galstyan GR, Tokmakova AYu, Egorova DN, Mitish VA, et al. Clinical guidelines for the diagnosis and treatment of diabetic foot syndrome. Rany i ranevye infekcii. Zhurnal im. prof. B.M. Kostjuchjonka. 2015; 2: 61-83. (In Russ.)

3. IDF Diabetes Atlas, 8th ed. Brussels, International Diabetes Federation; 2017: 148.

4. Dedov II, Shestakova MV, Vikulova OK. State Register of Diabetes Mellitus in the Russian Federation: Status of 2014 and Prospects. Saharnyj diabet. 2015; 9: 5-22. (In Russ.)

5. Guryeva IV. Faktory riska razvitiya sindroma diabeticheskoy stopy. Russkiy meditsinskiy zhurnal. 2003; 6: 338. (In Russ.)

6. Wagner FM. A classification and treatment program for diabetic, neuropathic and dysvascular foot problems. In: American Academy of Ortopaedic Surgeons instructional course lectures. St. Louis, Mosby. 1979: 143-65.

7. Treece KA, Macfarlane RM, Pound N, et al. Validation of a system of foot ulcer classification in diabetes mellitus. Diabet Med. 2004; 21(9): 987-91. doi: 10.1111/j.1464-5491.2004.01275.x.

8. Keast DH, Bowering CK, Evans AW, et al. MEASURE: A proposed assessment framework for developing best practice recommendations for wound assessment. Wound Repair Regen. 2004; 12: 1-17. doi: 10.1111/j.1067-1927.2004.0123S1.

9. Tupikin RS, Chibirov SK, Zebelyan AA, Fedorchenko AN, Porkhanov VA. Modern classification of diabetic foot syndrome SVS WIFI. Innovacionnaja medicina Kubani. 2018; 10: 73-78. (In Russ.)

10. Zhan LX, Branco BC, Armstrong DG, Mills JL Sr. The Society for Vascular Surgery lower extremity threatened limb classification system based on Wound, Ischemia, and foot Infection (WIfI) correlates with risk of major amputation and time to wound healing. J Vasc Surg. 2015; 61(4): 939-44. doi: 10.1016/j.jvs.2014.11.045.

11. Mizin AG, Udovichenko OV, Terekhin SA. Critical ischemia of the lower extremities and ischemic forms of diabetic foot syndrome. Moscow, 2017. (In Russ.)

12. Prompers L, Huijberts M, Schaper N, et al. Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study. Diabetologia. 2008; 51: 1826-1834. doi: 10.1007/s00125-008-1089-6.

13. Aliev MA, Safarov SYu, Magomedov MS. Results of using balloon angioplasty for critical lower limb ischemia in the complex treatment of diabetic foot syndrome. Vysokie amputacii nizhnih konechnostej u detej i vzroslyh. Sbornik nauchnyh trudov mezhdunarodnoj nauchno-prakticheskoj konferencii. M.: Pero, 2019: 9-11. (In Russ.)

14. Plekhanov AN, Markevich PS. Diabetic foot syndrome: modern approaches to diagnosis. Klinicheskaja medicina. 2014; 92: 29-33. (In Russ.)

15. Bernik YaK, Kuznetsov KA, Ibragimova ZV, et al. Gabapentin therapy for post-amputation phantom pain syndrome in patients with obliterating atherosclerosis. Vysokie amputacii nizhnih konechnostej u detej i vzroslyh. Sbornik nauchnyh trudov mezhdunarodnoj nauchno-prakticheskoj konferencii. M.: Pero, 2019: 39-41. (In Russ.)

16. Baulin AA, Pyanov NA, Peskov AV, et al. Amputation at the hip level in diabetes and atherosclerosis. Vysokie amputacii nizhnih konechnostej u detej i vzroslyh. Sbornik nauchnyh trudov mezhdunarodnoj nauchno-prakticheskoj konferencii. M.: Pero, 2019: 30-34. (In Russ.)

17. Begma AN, Begma IV. Evaluation of various methods of surgical treatment and the optimal model of surgical rehabilitation for patients with disabilities with diabetic foot syndrome. Mediko-social’nye problemy invalidnosti. 2012; 2: 51-56. (In Russ.)

18. Rundo AI. Modern aspects of the etiology and pathogenesis of diabetic foot syndrome. Novosti hirurgii. 2015; 23: 97-104. (In Russ.)

19. Kislyakov VA. Diabetic foot syndrome: demographic, economic, social, medical significance of the problem (literature review). Spravochnik vracha obshhej praktiki. 2016; 1: 7-9. (In Russ.)

20. Schaper NC, van Netten JJ, Apelqvist J, et al. Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev. 2020: 36. doi: 10.1002/dmrr.3266.

21. Klyushkin IV, Fatykhov RI. Modern diagnostic methods in diabetic foot syndrome // Kazan medical journal. 2012; 93(2): 298-301. (In Russ.) doi: 10.17816/KMJ2313.

22. Boulton AJ, Vileikyte L. The diabetic foot: the scope of the problem. J. Fam. Pract. 2000; 49: 3-8.

23. Lipsky BA, Berendt AR, Deery HG, et al. Diagnosis and treatment of diabetic foot infections. Plastic and reconstructive surgery. 2006; 117: 212-238. doi: 10.1097/01.prs.0000222737.09322.77.

24. Ahmadi ME, Morrison WB, Carrino JA, et al. Neuropathic arthropathy of the foot with and without superimposed osteomyelitis: MR imaging characteristics. Radiology. 2006; 238: 622-631. doi: 10.1148/radiol.2382041393.

25. Prandini N, Lazzeri E, Rossi B, et al. Nuclear medicine imaging of bone infections. Nucl Med Commun. 2006; 8: 633-644. doi: 10.1097/00006231-200608000-00006.

26. Kumar V Radiolabeled white blood cells and direct targeting of microorganisms for infection imaging. Nuc. Med. Mol. Imaging. 2005; 49: 325-338.

27. Chantelau E. The fate of the ischemic limb in diabetes: in is neuropathy that makes difference. VASA: Journal for vascular diseases. 2001; 58: 15-20. doi: 10.1024/0301-1526.30.S58.15.

28. El Sakka K, Fassiadis N, Gambhir RP, et al. An integrated care pathway to save the critically ischaemic diabetic foot. Int J Clin Pract. 2006; 60: 667-669. doi: 10.1111/j.1368-5031.2006.00953.x.

29. Olin JW, Sealov BA Peripheral artery disease: current insight into the disease and its diagnosis and management. Mayo Clin. Proc. 2010; 85(7): 678-692. doi: 10.4065/mcp.2010.0133.

30. Kalashnikova MF, Maksimova NV, Udovichenko OV, Suntsov YUI. Farmakoekonomicheskiye aspekty lecheniya sindroma diabeticheskoy stopy. Sakharnyy diabet. 2010; 2: 113-119. (In Russ.)

31. International Working Group on the Diabetic Foot. International Consensus on the Diabetic Foot and Practical Guidelines on the Management and the Prevention of the Diabetic Foot, 2007. [URL]

32. Yesipov AV, Yamenskov VV, Zinovyev PA, et al. Sistema gemostaza i ateroskleroz. Gospital′naya meditsina: nauka i praktika. 2022. 5(2): 45-50. (In Russ.) doi: 10.34852/GM3CVKG.2022.64.12.009.

33. Vyrenkov YUE, Vtorenko VI, Yesipov AV, et al. Perspektivy i vozmozhnosti pryamoy endolimfaticheskoy terapii v lechenii oslozhnennykh form sakharnogo diabeta. Moskovskiy khirurgicheskiy zhurnal. 2015; 2(42): 21-25. (In Russ.)

34. Bryusov PG, Lishchuk AN, Potapov VA. Development of the concept of complex treatment postoperative sternomediastinitis. Clinical Medicine. 2022; 100(9-10): 439-446. (In Russ.) doi: 10.30629/0023-2149-2022-100-9-10-439-446.

For citation

Yesipov A.V., Alekhnovich A.V., Musailov V.A., Markevich P.S., Potapov V.A. Actual problems of diagnosis of diabetic foot syndrome. Bulletin of Pirogov National Medical & Surgical Center. 2023;18(2):115-120. (In Russ.)