{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,8]],"date-time":"2026-11-08T12:31:02Z","timestamp":1794141062482,"version":"4.8.0"},"reference-count":96,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2023,7,3]]},"abstract":"<jats:sec id=\"ab-jrv230012-1\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Approximately 18.6 million people worldwide are affected by a diabetic foot ulcer each year, including 1.6 million people in the United States. These ulcers precede 80% of lower extremity amputations among people diagnosed with diabetes and are associated with an increased risk of death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-jrv230012-2\">\n                    <jats:title>Observations<\/jats:title>\n                    <jats:p>Neurological, vascular, and biomechanical factors contribute to diabetic foot ulceration. Approximately 50% to 60% of ulcers become infected, and about 20% of moderate to severe infections lead to lower extremity amputations. The 5-year mortality rate for individuals with a diabetic foot ulcer is approximately 30%, exceeding 70% for those with a major amputation. The mortality rate for people with diabetic foot ulcers is 231 deaths per 1000 person-years, compared with 182 deaths per 1000 person-years in people with diabetes without foot ulcers. People who are Black, Hispanic, or Native American and people with low socioeconomic status have higher rates of diabetic foot ulcer and subsequent amputation compared with White people. Classifying ulcers based on the degree of tissue loss, ischemia, and infection can help identify risk of limb-threatening disease. Several interventions reduce risk of ulcers compared with usual care, such as pressure-relieving footwear (13.3% vs 25.4%; relative risk, 0.49; 95% CI, 0.28-0.84), foot skin measurements with off-loading when hot spots (ie, greater than 2 \u00b0C difference between the affected foot and the unaffected foot) are found (18.7% vs 30.8%; relative risk, 0.51; 95% CI, 0.31-0.84), and treatment of preulcer signs. Surgical debridement, reducing pressure from weight bearing on the ulcer, and treating lower extremity ischemia and foot infection are first-line therapies for diabetic foot ulcers. Randomized clinical trials support treatments to accelerate wound healing and culture-directed oral antibiotics for localized osteomyelitis. Multidisciplinary care, typically consisting of podiatrists, infectious disease specialists, and vascular surgeons, in close collaboration with primary care clinicians, is associated with lower major amputation rates relative to usual care (3.2% vs 4.4%; odds ratio, 0.40; 95% CI, 0.32-0.51). Approximately 30% to 40% of diabetic foot ulcers heal at 12 weeks, and recurrence after healing is estimated to be 42% at 1 year and 65% at 5 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-jrv230012-3\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>Diabetic foot ulcers affect approximately 18.6 million people worldwide each year and are associated with increased rates of amputation and death. Surgical debridement, reducing pressure from weight bearing, treating lower extremity ischemia and foot infection, and early referral for multidisciplinary care are first-line therapies for diabetic foot ulcers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jama.2023.10578","type":"journal-article","created":{"date-parts":[[2023,7,3]],"date-time":"2023-07-03T11:05:50Z","timestamp":1688382350000},"page":"62","source":"Crossref","is-referenced-by-count":1785,"title":["Diabetic Foot Ulcers"],"prefix":"10.1001","volume":"330","author":[{"given":"David G.","family":"Armstrong","sequence":"first","affiliation":[{"name":"Department of Surgery, Keck School of Medicine at the University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tze-Woei","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Keck School of Medicine at the University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J. M.","family":"Boulton","sequence":"additional","affiliation":[{"name":"Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, England"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sicco A.","family":"Bus","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"5","key":"jrv230012r1","doi-asserted-by":"publisher","first-page":"964","DOI":"10.2337\/dc19-1614","article-title":"Global disability burdens of diabetes-related lower-extremity complications in 1990 and 2016.","volume":"43","author":"Zhang","year":"2020","journal-title":"Diabetes Care"},{"issue":"24","key":"jrv230012r2","doi-asserted-by":"publisher","first-page":"2367","DOI":"10.1056\/NEJMra1615439","article-title":"Diabetic foot ulcers and their recurrence.","volume":"376","author":"Armstrong","year":"2017","journal-title":"N Engl J Med"},{"key":"jrv230012r3","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.109182","article-title":"Higher rates of all-cause mortality and resource utilization during episodes-of-care for diabetic foot ulceration.","volume":"184","author":"Petersen","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"issue":"1","key":"jrv230012r4","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1111\/dme.13537","article-title":"Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study.","volume":"35","author":"Ndosi","year":"2018","journal-title":"Diabet Med"},{"issue":"1","key":"jrv230012r5","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1007\/s00125-006-0491-1","article-title":"High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe: baseline results from the Eurodiale study.","volume":"50","author":"Prompers","year":"2007","journal-title":"Diabetologia"},{"issue":"8","key":"jrv230012r6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0134914","article-title":"A diabetic emergency one million feet long: disparities and burdens of illness among diabetic foot ulcer cases within emergency departments in the United States, 2006-2010.","volume":"10","author":"Skrepnek","year":"2015","journal-title":"PLoS One"},{"issue":"1","key":"jrv230012r8","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s13047-020-00383-2","article-title":"Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer.","volume":"13","author":"Armstrong","year":"2020","journal-title":"J Foot Ankle Res"},{"issue":"3","key":"jrv230012r9","doi-asserted-by":"publisher","first-page":"651","DOI":"10.2337\/dc13-2176","article-title":"Burden of diabetic foot ulcers for Medicare and private insurers.","volume":"37","author":"Rice","year":"2014","journal-title":"Diabetes Care"},{"issue":"1","key":"jrv230012r12","doi-asserted-by":"publisher","first-page":"209","DOI":"10.2337\/dci22-0043","article-title":"Etiology, epidemiology, and disparities in the burden of diabetic foot ulcers.","volume":"46","author":"McDermott","year":"2023","journal-title":"Diabetes Care"},{"key":"jrv230012r13","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciad255","article-title":"Evaluation and management of diabetes-related foot infections.","author":"Cortes-Penfield","year":"2023","journal-title":"Clin Infect Dis"},{"issue":"3","key":"jrv230012r14","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1016\/j.ejvs.2018.04.017","article-title":"International variations in amputation practice: a VASCUNET report.","volume":"56","author":"Behrendt","year":"2018","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"1","key":"jrv230012r15","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2020-001328","article-title":"Association between race\/ethnicity and the risk of amputation of lower extremities among Medicare beneficiaries with diabetic foot ulcers and diabetic foot infections.","volume":"8","author":"Tan","year":"2020","journal-title":"BMJ Open Diabetes Res Care"},{"issue":"2","key":"jrv230012r16","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0211481","article-title":"Disparities in outcomes of patients admitted with diabetic foot infections.","volume":"14","author":"Tan","year":"2019","journal-title":"PLoS One"},{"issue":"1","key":"jrv230012r17","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1111\/jdb.2014.6.issue-1","article-title":"Disparities in initial presentation and treatment outcomes of diabetic foot ulcers in a public, private, and Veterans Administration hospital.","volume":"6","author":"Blumberg","year":"2014","journal-title":"J Diabetes"},{"issue":"7","key":"jrv230012r18","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1001\/jamasurg.2013.1436","article-title":"Influence of race on the management of lower extremity ischemia: revascularization vs amputation.","volume":"148","author":"Durazzo","year":"2013","journal-title":"JAMA Surg"},{"issue":"10","key":"jrv230012r19","doi-asserted-by":"publisher","first-page":"2336","DOI":"10.2337\/dc21-2693","article-title":"Racial disparities in health care with timing to amputation following diabetic foot ulcer.","volume":"45","author":"Miller","year":"2022","journal-title":"Diabetes Care"},{"issue":"3","key":"jrv230012r20","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1007\/s00125-019-05056-9","article-title":"Geospatial mapping and data linkage uncovers variability in outcomes of foot disease according to multiple deprivation: a population cohort study of people with diabetes.","volume":"63","author":"Hurst","year":"2020","journal-title":"Diabetologia"},{"issue":"8","key":"jrv230012r21","doi-asserted-by":"publisher","first-page":"1383","DOI":"10.1377\/hlthaff.2014.0148","article-title":"Geographic clustering of diabetic lower-extremity amputations in low-income regions of California.","volume":"33","author":"Stevens","year":"2014","journal-title":"Health Aff (Millwood)"},{"issue":"9","key":"jrv230012r22","doi-asserted-by":"publisher","first-page":"2053","DOI":"10.2337\/dc20-3135","article-title":"Racial, rural, and regional disparities in diabetes-related lower-extremity amputation rates, 2009-2017.","volume":"44","author":"Akinlotan","year":"2021","journal-title":"Diabetes Care"},{"issue":"4","key":"jrv230012r23","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.8399","article-title":"Association of race, ethnicity, and rurality with major leg amputation or death among Medicare beneficiaries hospitalized with diabetic foot ulcers.","volume":"5","author":"Brennan","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"2","key":"jrv230012r24","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1111\/dme.v37.2","article-title":"Foot ulceration and its association with mortality in diabetes mellitus: a meta-analysis.","volume":"37","author":"Saluja","year":"2020","journal-title":"Diabet Med"},{"issue":"3","key":"jrv230012r25","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1016\/j.jdiacomp.2016.11.020","article-title":"Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes.","volume":"31","author":"Brennan","year":"2017","journal-title":"J Diabetes Complications"},{"key":"jrv230012r26","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3657","article-title":"Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update).","author":"Schaper","year":"2023","journal-title":"Diabetes Metab Res Rev"},{"key":"jrv230012r27","article-title":"Association of pre-ulcerative foot care and outcomes of diabetic foot ulceration.","author":"Tolson","journal-title":"J Am Podiatr Med Assoc"},{"key":"jrv230012r28","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3651","article-title":"Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update).","author":"Bus","year":"202311","journal-title":"Diabetes Metab Res Rev"},{"issue":"15","key":"jrv230012r30","doi-asserted-by":"publisher","first-page":"1526","DOI":"10.1001\/jama.2010.428","article-title":"Does this patient with diabetes have large-fiber peripheral neuropathy?","volume":"303","author":"Kanji","year":"2010","journal-title":"JAMA"},{"issue":"9","key":"jrv230012r31","doi-asserted-by":"publisher","first-page":"479","DOI":"10.7547\/87507315-92-9-479","article-title":"Ankle equinus deformity and its relationship to high plantar pressure in a large population with diabetes mellitus.","volume":"92","author":"Lavery","year":"2002","journal-title":"J Am Podiatr Med Assoc"},{"key":"jrv230012r32","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3646","article-title":"Guidelines on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes mellitus (IWGDF 2023).","author":"Wukich","year":"2023","journal-title":"Diabetes Metab Res Rev"},{"issue":"21","key":"jrv230012r33","doi-asserted-by":"publisher","first-page":"2188","DOI":"10.1001\/jama.2021.2126","article-title":"Lower extremity peripheral artery disease without chronic limb-threatening ischemia: a review.","volume":"325","author":"Polonsky","year":"2021","journal-title":"JAMA"},{"issue":"5","key":"jrv230012r34","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1016\/j.jvs.2015.11.044","article-title":"Pulse palpation is an effective method for population-based screening to exclude peripheral arterial disease.","volume":"63","author":"Londero","year":"2016","journal-title":"J Vasc Surg"},{"key":"jrv230012r36","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3645","article-title":"Classification of foot ulcers in people with diabetes: a systematic review.","author":"Monteiro-Soares","year":"2023","journal-title":"Diabetes Metab Res Rev"},{"key":"jrv230012r37","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3648","article-title":"Guidelines on the classification of foot ulcers in people with diabetes (IWGDF 2023 update).","author":"Monteiro-Soares","year":"2023","journal-title":"Diabetes Metab Res Rev"},{"issue":"1","key":"jrv230012r38","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1016\/j.jvs.2013.08.003","article-title":"The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI).","volume":"59","author":"Mills","year":"2014","journal-title":"J Vasc Surg"},{"issue":"3","key":"jrv230012r39","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1016\/j.ejvs.2019.03.040","article-title":"The prognostic value of the WIfI classification in patients with chronic limb threatening ischaemia: a systematic review and meta-analysis.","volume":"58","author":"van Reijen","year":"2019","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"7","key":"jrv230012r40","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1001\/jama.299.7.806","article-title":"Does this patient with diabetes have osteomyelitis of the lower extremity?","volume":"299","author":"Butalia","year":"2008","journal-title":"JAMA"},{"issue":"2","key":"jrv230012r41","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1111\/dme.2011.28.issue-2","article-title":"Diagnosing diabetic foot osteomyelitis: is the combination of probe-to-bone test and plain radiography sufficient for high-risk inpatients?","volume":"28","author":"Arag\u00f3n-S\u00e1nchez","year":"2011","journal-title":"Diabet Med"},{"issue":"3","key":"jrv230012r42","doi-asserted-by":"publisher","first-page":"373","DOI":"10.2174\/1573399816999200729124134","article-title":"X-ray versus magnetic resonance imaging in diabetic foot osteomyelitis: a clinical comparison.","volume":"17","author":"Gariani","year":"2021","journal-title":"Curr Diabetes Rev"},{"issue":"8","key":"jrv230012r43","doi-asserted-by":"publisher","first-page":"1111","DOI":"10.2337\/dc17-0532","article-title":"Detection of osteomyelitis in the diabetic foot by imaging techniques: a systematic review and meta-analysis comparing MRI, white blood cell scintigraphy, and FDG-PET.","volume":"40","author":"Lauri","year":"2017","journal-title":"Diabetes Care"},{"issue":"2","key":"jrv230012r44","doi-asserted-by":"publisher","first-page":"29S","DOI":"10.1016\/j.jvs.2015.10.004","article-title":"A systematic review and meta-analysis of tests to predict wound healing in diabetic foot.","volume":"63","author":"Wang","year":"2016","journal-title":"J Vasc Surg"},{"key":"jrv230012r45","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1002\/dmrr.2704","article-title":"Performance of prognostic markers in the prediction of wound healing or amputation among patients with foot ulcers in diabetes: a systematic review.","volume":"32","author":"Brownrigg","year":"2016","journal-title":"Diabetes Metab Res Rev"},{"issue":"3","key":"jrv230012r46","doi-asserted-by":"publisher","DOI":"10.1177\/1479164120928868","article-title":"Do toe blood pressures predict healing after minor lower limb amputation in people with diabetes? a systematic review and meta-analysis.","volume":"17","author":"Linton","year":"2020","journal-title":"Diab Vasc Dis Res"},{"key":"jrv230012r47","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1016\/j.avsg.2019.04.011","article-title":"Toe pressure in predicting diabetic foot ulcer healing: a systematic review and meta-analysis.","volume":"60","author":"Tay","year":"2019","journal-title":"Ann Vasc Surg"},{"issue":"8","key":"jrv230012r48","doi-asserted-by":"publisher","first-page":"1679","DOI":"10.2337\/dc08-9021","article-title":"Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists.","volume":"31","author":"Boulton","year":"2008","journal-title":"Diabetes Care"},{"issue":"6S","key":"jrv230012r49","doi-asserted-by":"publisher","first-page":"3S","DOI":"10.1016\/j.jvs.2019.02.016","article-title":"Global Vascular Guidelines on the management of chronic limb-threatening ischemia.","volume":"69","author":"Conte","year":"2019","journal-title":"J Vasc Surg"},{"issue":"6","key":"jrv230012r50","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.v38.6","article-title":"Efficacy of at home monitoring of foot temperature for risk reduction of diabetes-related foot ulcer: a meta-analysis.","volume":"38","author":"Golledge","year":"2022","journal-title":"Diabetes Metab Res Rev"},{"key":"jrv230012r51","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3647","article-title":"Guidelines on offloading foot ulcers in persons with diabetes\u2014IWGDF 2023 update.","author":"Bus","year":"2023","journal-title":"Diabetes Metab Res Rev"},{"key":"jrv230012r52","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3644","article-title":"Guidelines on interventions to enhance healing of foot ulcers in people with diabetes (IWGDF 2023 update).","author":"Chen","year":"2023","journal-title":"Diabetes Metab Res Rev"},{"issue":"2","key":"jrv230012r53","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1111\/wrr.v30.2","article-title":"Chronic wounds: treatment consensus.","volume":"30","author":"Eriksson","year":"2022","journal-title":"Wound Repair Regen"},{"issue":"9","key":"jrv230012r54","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1001\/jamadermatol.2013.4960","article-title":"Frequency of debridements and time to heal: a retrospective cohort study of 312?744 wounds.","volume":"149","author":"Wilcox","year":"2013","journal-title":"JAMA Dermatol"},{"issue":"3","key":"jrv230012r55","doi-asserted-by":"publisher","first-page":"179S","DOI":"10.1097\/PRS.0000000000002686","article-title":"The role of pressure offloading on diabetic foot ulcer healing and prevention of recurrence.","volume":"138","author":"Bus","year":"2016","journal-title":"Plast Reconstr Surg"},{"issue":"11","key":"jrv230012r56","doi-asserted-by":"publisher","first-page":"2118","DOI":"10.2337\/dc08-0771","article-title":"Use of pressure offloading devices in diabetic foot ulcers: do we practice what we preach?","volume":"31","author":"Wu","year":"2008","journal-title":"Diabetes Care"},{"key":"jrv230012r57","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/s13047-014-0035-8","article-title":"A survey of offloading practices for diabetes-related plantar neuropathic foot ulcers.","volume":"7","author":"Raspovic","year":"2014","journal-title":"J Foot Ankle Res"},{"key":"jrv230012r58","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3650","article-title":"Effectiveness of offloading interventions for people with diabetes-related foot ulcers: a systematic review and meta analysis.","author":"Lazzarini","year":"2023","journal-title":"Diabetes Metab Res Rev"},{"issue":"9","key":"jrv230012r59","doi-asserted-by":"publisher","first-page":"2595","DOI":"10.2337\/diacare.26.9.2595","article-title":"Activity patterns of patients with diabetic foot ulceration: patients with active ulceration may not adhere to a standard pressure off-loading regimen.","volume":"26","author":"Armstrong","year":"2003","journal-title":"Diabetes Care"},{"issue":"11","key":"jrv230012r60","doi-asserted-by":"publisher","first-page":"2492","DOI":"10.2337\/dc22-0085","article-title":"Flexor tendon tenotomy treatment of the diabetic foot: a multicenter randomized controlled trial.","volume":"45","author":"Andersen","year":"2022","journal-title":"Diabetes Care"},{"issue":"8","key":"jrv230012r61","doi-asserted-by":"publisher","first-page":"1436","DOI":"10.2106\/00004623-200308000-00003","article-title":"Effect of Achilles tendon lengthening on neuropathic plantar ulcers: a randomized clinical trial.","volume":"85","author":"Mueller","year":"2003","journal-title":"J Bone Joint Surg Am"},{"issue":"4","key":"jrv230012r62","doi-asserted-by":"publisher","first-page":"645","DOI":"10.2337\/dc17-1836","article-title":"Current challenges and opportunities in the prevention and management of diabetic foot ulcers.","volume":"41","author":"Jeffcoate","year":"2018","journal-title":"Diabetes Care"},{"issue":"11","key":"jrv230012r65","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1016\/S2213-8587(18)30240-7","article-title":"LeucoPatch system for the management of hard-to-heal diabetic foot ulcers in the UK, Denmark, and Sweden: an observer-masked, randomised controlled trial.","volume":"6","author":"Game","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"5","key":"jrv230012r66","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1111\/iwj.2014.11.issue-5","article-title":"The efficacy and safety of Grafix for the treatment of chronic diabetic foot ulcers: results of a multi-centre, controlled, randomised, blinded, clinical trial.","volume":"11","author":"Lavery","year":"2014","journal-title":"Int Wound J"},{"issue":"1","key":"jrv230012r67","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1111\/iwj.2019.16.issue-1","article-title":"A confirmatory study on the efficacy of dehydrated human amnion\/chorion membrane dHACM allograft in the management of diabetic foot ulcers: a prospective, multicentre, randomised, controlled study of 110 patients from 14 wound clinics.","volume":"16","author":"Tettelbach","year":"2019","journal-title":"Int Wound J"},{"issue":"1","key":"jrv230012r68","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1186\/s13047-022-00575-y","article-title":"Human amniotic membrane products for patients with diabetic foot ulcers. do they help? a systematic review and meta-analysis.","volume":"15","author":"Mohammed","year":"2022","journal-title":"J Foot Ankle Res"},{"issue":"3","key":"jrv230012r69","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1016\/S2213-8587(17)30438-2","article-title":"Sucrose octasulfate dressing versus control dressing in patients with neuroischaemic diabetic foot ulcers (EXPLORER): an international, multicentre, double-blind, randomised, controlled trial.","volume":"6","author":"Edmonds","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"5","key":"jrv230012r70","doi-asserted-by":"publisher","first-page":"998","DOI":"10.2337\/dc09-1754","article-title":"Hyperbaric oxygen therapy facilitates healing of chronic foot ulcers in patients with diabetes.","volume":"33","author":"L\u00f6ndahl","year":"2010","journal-title":"Diabetes Care"},{"issue":"1","key":"jrv230012r71","doi-asserted-by":"publisher","first-page":"112","DOI":"10.2337\/dc17-0654","article-title":"Hyperbaric oxygen therapy in the treatment of ischemic lower- extremity ulcers in patients with diabetes: results of the DAMO2CLES multicenter randomized clinical trial.","volume":"41","author":"Santema","year":"2018","journal-title":"Diabetes Care"},{"issue":"4","key":"jrv230012r72","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1089\/wound.2022.0041","article-title":"Efficacy of topical wound oxygen therapy in healing chronic diabetic foot ulcers: systematic review and meta-analysis.","volume":"12","author":"Carter","year":"2023","journal-title":"Adv Wound Care (New Rochelle)"},{"issue":"10","key":"jrv230012r73","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD010318.pub3","article-title":"Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus.","volume":"10","author":"Liu","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"issue":"10","key":"jrv230012r74","doi-asserted-by":"publisher","first-page":"10830","DOI":"10.21037\/apm","article-title":"A systematic review and meta-analysis of efficacy and safety of negative pressure wound therapy in the treatment of diabetic foot ulcer.","volume":"10","author":"Chen","year":"2021","journal-title":"Ann Palliat Med"},{"issue":"9498","key":"jrv230012r75","doi-asserted-by":"publisher","first-page":"1704","DOI":"10.1016\/S0140-6736(05)67695-7","article-title":"Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial.","volume":"366","author":"Armstrong","year":"2005","journal-title":"Lancet"},{"issue":"6","key":"jrv230012r76","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.1016\/j.jvs.2013.12.046","article-title":"Split-thickness skin grafting the high-risk diabetic foot.","volume":"59","author":"Rose","year":"2014","journal-title":"J Vasc Surg"},{"key":"jrv230012r77","doi-asserted-by":"publisher","first-page":"S203","DOI":"10.2337\/dc23-S012","article-title":"Retinopathy, neuropathy, and foot care: standards of care in diabetes\u20142023.","volume":"46","author":"ElSayed","year":"2023","journal-title":"Diabetes Care"},{"issue":"1","key":"jrv230012r78","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s12875-020-01363-y","article-title":"The analysis for time of referral to a medical center among patients with diabetic foot infection.","volume":"22","author":"Lin","year":"2021","journal-title":"BMC Fam Pract"},{"issue":"3","key":"jrv230012r79","doi-asserted-by":"publisher","first-page":"789","DOI":"10.2337\/dc13-1526","article-title":"Antibiotics versus conservative surgery for treating diabetic foot osteomyelitis: a randomized comparative trial.","volume":"37","author":"L\u00e1zaro-Mart\u00ednez","year":"2014","journal-title":"Diabetes Care"},{"issue":"4","key":"jrv230012r80","doi-asserted-by":"publisher","first-page":"1232","DOI":"10.1016\/j.jvs.2021.03.017","article-title":"Evaluation of revascularization benefit quartiles using the Wound, Ischemia, and Foot Infection classification system for diabetic patients with chronic limb-threatening ischemia.","volume":"74","author":"Hicks","year":"2021","journal-title":"J Vasc Surg"},{"issue":"4","key":"jrv230012r81","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1016\/j.ejvs.2014.06.041","article-title":"Early revascularization after admittance to a diabetic foot center affects the healing probability of ischemic foot ulcer in patients with diabetes.","volume":"48","author":"Elgzyri","year":"2014","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"2","key":"jrv230012r82","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1016\/j.ejvs.2016.10.023","article-title":"Analysis of the elective treatment process for critical limb ischaemia with tissue loss: diabetic patients require rapid revascularisation.","volume":"53","author":"Noronen","year":"2017","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"7","key":"jrv230012r83","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.118.006778","article-title":"Impact of frailty on clinical outcomes in patients with critical limb ischemia.","volume":"11","author":"Takeji","year":"2018","journal-title":"Circ Cardiovasc Interv"},{"issue":"25","key":"jrv230012r84","doi-asserted-by":"publisher","first-page":"2305","DOI":"10.1056\/NEJMoa2207899","article-title":"Surgery or endovascular therapy for chronic limb-threatening ischemia.","volume":"387","author":"Farber","year":"2022","journal-title":"N Engl J Med"},{"issue":"4","key":"jrv230012r85","doi-asserted-by":"publisher","first-page":"1433","DOI":"10.1016\/j.jvs.2019.08.244","article-title":"A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers.","volume":"71","author":"Musuuza","year":"2020","journal-title":"J Vasc Surg"},{"issue":"4","key":"jrv230012r86","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2020.107837","article-title":"A systematic review with meta-analysis of the impact of access and quality of diabetic foot care delivery in preventing lower extremity amputation.","volume":"35","author":"Monteiro-Soares","year":"2021","journal-title":"J Diabetes Complications"},{"key":"jrv230012r87","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/9742665","article-title":"Effects of special therapeutic footwear on the prevention of diabetic foot ulcers: a systematic review and meta-analysis of randomized controlled trials.","volume":"2022","author":"Luo","year":"2022","journal-title":"J Diabetes Res"},{"issue":"2","key":"jrv230012r88","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1177\/1534734620929892","article-title":"The incidence of depression in patients with diabetic foot ulcers: a systematic review and meta-analysis.","volume":"21","author":"Jiang","year":"2022","journal-title":"Int J Low Extrem Wounds"},{"issue":"2","key":"jrv230012r89","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1007\/s00125-011-2359-2","article-title":"Five-year follow-up of a cohort of people with their first diabetic foot ulcer: the persistent effect of depression on mortality.","volume":"55","author":"Winkley","year":"2012","journal-title":"Diabetologia"},{"issue":"9","key":"jrv230012r91","doi-asserted-by":"publisher","first-page":"1906","DOI":"10.1007\/s00125-005-1856-6","article-title":"Health-related quality of life of diabetic foot ulcer patients and their caregivers.","volume":"48","author":"Nabuurs-Franssen","year":"2005","journal-title":"Diabetologia"},{"issue":"3","key":"jrv230012r92","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1089\/wound.2017.0743","article-title":"Publicly reported wound healing rates: the fantasy and the reality.","volume":"7","author":"Fife","year":"2018","journal-title":"Adv Wound Care (New Rochelle)"},{"key":"jrv230012r93","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3652","article-title":"Prevention of foot ulcers in people with diabetes at risk of ulceration: a systematic review and meta-analysis.","author":"Van Netten","year":"2023","journal-title":"Diabetes Metab Res Rev"},{"issue":"1","key":"jrv230012r94","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1111\/iwj.v20.1","article-title":"Association between vitamin D deficiency and diabetic foot ulcer wound in diabetic subjects: a meta-analysis.","volume":"20","author":"Lin","year":"2023","journal-title":"Int Wound J"},{"issue":"10","key":"jrv230012r95","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2020.107638","article-title":"Glycemic control and diabetic foot ulcer outcomes: a systematic review and meta-analysis of observational studies.","volume":"34","author":"Lane","year":"2020","journal-title":"J Diabetes Complications"},{"issue":"1","key":"jrv230012r96","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13047-020-0369-3","article-title":"Ulcer metastasis? anatomical locations of recurrence for patients in diabetic foot remission.","volume":"13","author":"Petersen","year":"2020","journal-title":"J Foot Ankle Res"},{"key":"jrv230012r63","volume-title":"Rutherford\u2019s Vascular Surgery and Endovascular Therapy","author":"Woelfel","year":"2022","edition":"10th ed"},{"key":"jrv230012r64","doi-asserted-by":"crossref","DOI":"10.2337\/db2022-02","volume-title":"New Evidence-Based Therapies for Complex Diabetic Foot Wounds","author":"Boulton","year":"2022"},{"key":"jrv230012r7","unstructured":"Senneville? \u00c9, Albalawi? Z, van Asten? SA, . Guidelines on the Diagnosis and Treatment of Foot Infection in Persons With Diabetes: IWGDF\/IDSA 2023. Published 2023. Accessed June 12, 2023. https:\/\/iwgdfguidelines.org\/wp-content\/uploads\/2023\/05\/IWGDF-2023-04-Infection-Guideline.pdf"},{"key":"jrv230012r10","unstructured":"International Diabetes Federation. IDF Diabetes Atlas, 10th ed. https:\/\/www.diabetesatlas.org"},{"key":"jrv230012r11","unstructured":"Centers for Disease Control and Prevention. National Diabetes Statistics Report. Updated June 29, 2022. Accessed May 28, 2023. https:\/\/www.cdc.gov\/diabetes\/data\/statistics-report\/index.html"},{"key":"jrv230012r29","unstructured":"Stang? D, Leese? GP. The Scottish Diabetes Foot Action Group 2016 Update of the Diabetic Foot Risk Stratification and Triage System. Published March 1, 2017. Accessed July 1, 2022. https:\/\/woundsinternational.com\/journal-articles\/the-scottish-diabetes-foot-action-group-2016-update-of-the-diabetic-foot-risk-stratification-and-triage-system\/"},{"key":"jrv230012r35","unstructured":"IWGDF PAD Working Group. Intersocietal PAD Guideline (2023 Update). Accessed June 12, 2023. https:\/\/iwgdfguidelines.org\/pad-guideline-2023\/"},{"key":"jrv230012r90","unstructured":"Armstrong? DG, Mills? JL, Molina? M, Molnar? JA. Nutrition interventions in adults with diabetic foot ulcers. Guideline Central. Published March 2022. Accessed June 26, 2022. https:\/\/www.guidelinecentral.com\/guideline\/502765\/pocket-guide\/502768\/"}],"container-title":["JAMA"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/articlepdf\/2806655\/jama_armstrong_2023_rv_230012_1687532937.36501.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,3]],"date-time":"2023-07-03T11:05:58Z","timestamp":1688382358000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2806655"}},"subtitle":["A Review"],"short-title":[],"issued":{"date-parts":[[2023,7,3]]},"references-count":96,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,7,3]]}},"URL":"https:\/\/doi.org\/10.1001\/jama.2023.10578","relation":{},"ISSN":["0098-7484"],"issn-type":[{"value":"0098-7484","type":"print"}],"subject":[],"published":{"date-parts":[[2023,7,3]]}}}