II. Risk factors
III. Grading: Classification Systems for Diabetic Foot Ulcers
IV. Evaluation
- See Suspected Osteomyelitis in Diabetes Mellitus
- Assess vascular status
- Palpate popliteal pulse (should be present)
- Palpate pedal pulse
- Often absent in diabetic arterial disease
- Diabetes selectively affects distal tibial artery
V. Management
- All foot lesions
- Reduce pressure on foot lesion
- Optimize comorbid conditions
- Control Hypertension
- Improve glycemic control
- Maximize nutritional status
- Closed Foot Sores
- Warm water soaks (not hot) for 15 minutes twice daily
- Epson salts added to water may be soothing
- Hypoallergenic lotion to affected area bid
- Cotton socks
- Warm water soaks (not hot) for 15 minutes twice daily
- Ulcerated wounds
- See Wound Cleansing
- See Wound Debridement (debride necrotic tissue)
- Choose dressing to maintain warm, moist environment
- See Wound Dressing (inc. Pressure Sore Dressings)
- Hydrocolloid Dressing (avoid if wound infected)
- Transparent Film Dressing (avoid if wound infected)
- Foam Dressing
- Calcium Alginate Dressing
- Consider adjuncts to promote Wound Healing
- Growth factors (e.g. Becaplermin)
- Bioengineered skin grafts (Apligraf, Dermagraft)
- Ischemic wounds
- Revascularization or Angioplasty
- Hyperbaric oxygen therapy
- Reduces amputations due to Diabetic Foot Ulcers
- Roeckl-Wiedmann (2005) Br J Surg 92:24-32 [PubMed]
- Vasodilator drugs have not been efficacious
- Infected wounds
- See Cellulitis for infected diabetic wound management
- Findings suggestive of serious infection
- Cellulitis involves >2 cm of skin
- Deep ulcer
- Purulent drainage
- Fever
- Probe-to-Bone Test positive
VI. Prevention
VII. Prognosis: Foot Ulcer healing in Diabetes Mellitus
- Healing prediction based on 3 criteria (one point each)
- Foot Wound present >2 months
- Foot Wound >2 cm
- Grade 3 or more on Wagner Ulcer Classification
- Interpretation: Score of 2 or more
- Wound not healed in 79% of patients by 20 weeks
- References