School of Podiatric Medicine Publications and Presentations

Comparative Effectiveness of Conservative versus Early Surgical Treatments on Wound Healing Outcomes of Diabetic Foot Ulcers: A Literature Review

Document Type

Article

Publication Date

2025

Abstract

Diabetic foot ulcers (DFUs) are a severe complication of diabetes mellitus and the leading cause of lower extremity amputations worldwide. Peripheral neuropathy and peripheral arterial disease secondary to complications of diabetes mellitus may result in ulcers going unnoticed, increasing the risk of severe osteomyelitis, necrotizing infection, hospitalization, amputation, and sepsis. While conservative management of DFUs remains the first-line approach—emphasizing wound care, infection control, glycemic management, and offloading—there is growing debate about whether delaying simple surgical interventions worsens long-term outcomes. Surgeries such as tenotomy, digital amputation, and tendo-Achilles lengthening are minimally invasive options that can correct deformities, prevent recurrence, and promote healing. However, concerns about comorbidities and surgical risks often deter early intervention. The question remains: does delaying minor procedures contribute to worse outcomes, or would early intervention improve healing, reduce complications, and enhance quality of life?

This literature review evaluates prolonged conservative treatment with early surgical intervention in DFU management. While conservative methods remain essential, delays in surgery may contribute to chronic non-healing wounds, recurrent infections, and higher amputation rates. In contrast, timely surgical procedures can correct biomechanical issues, accelerate wound closure, and reduce the overall burden of care. There are shared concerns regarding patient comorbidities and surgical risks intrinsic to the procedure, postoperative abilities, and anesthesia risks deferring adopting early intervention strategies. How long is too long to wait? Current classification systems categorize the degree of infection or ischemia and risk of amputation. Future research should focus on integrating standardized classification systems to guide treatment stratification and better define when early surgical intervention provides superior long-term outcomes. By balancing conservative and surgical approaches of DFUs, clinicians may reduce prolonged wound burden, improve healing rates, and enhance patient quality of life.

First Page

7

Last Page

10

Publication Title

National Foot & Ankle Review

Academic Level

faculty

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