Holistic Management of Diabetic Foot Gangrene and Ulcer through Family Medicine Approach

An Evidence-Based Case Report

Abstract

Diabetic foot ulcers and gangrene are chronic complications of diabetes mellitus and a leading cause of non-traumatic amputation that reduce quality of life, so their management requires a holistic, preventive, and family-based approach. We report a 55-year-old woman with blackening of the second and third right toes and a purulent open wound for one month, with uncontrolled type 2 diabetes mellitus, peripheral artery disease, anaemia, and acute kidney injury on chronic kidney disease. She lived in a functional nuclear family (APGAR score 10). The working diagnosis was gangrene of digits 2 and 3 and a Wagner grade IV diabetic foot ulcer of the right foot. A literature search on PubMed, the Cochrane Library, and Google Scholar addressed whether family-involved foot care education improves outcomes compared with standard care. A systematic review of ten studies (5,532 patients, including two Indonesian randomised controlled trials) showed that family involvement in foot care education and skills training consistently improved foot care behaviour, diabetes knowledge, wound healing, and HbA1c, with a trend toward fewer amputations. After toe amputation and holistic, family-involved management, the postoperative wound granulated well and glycaemic control improved. Holistic management integrating surgical-vascular treatment, metabolic control, and strengthening of the family role is the most rational strategy to prevent recurrent ulceration and re-amputation.