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
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Related Studies
| Definition (MSH) | Lesion on the surface of the skin of the foot, usually accompanied by inflammation. The lesion may become infected or necrotic and is frequently associated with diabetes or leprosy. |
| Concepts | Disease or Syndrome (T047) , Acquired Abnormality (T020) |
| MSH | D016523 , D007871 |
| SnomedCT | 201249006, 301020006, 95345008 |
| English | Foot Ulcer, Foot Ulcers, Ulcers, Foot, Ulcer, Foot, Foot ulcerations, foot ulcer (physical finding), foot ulcer, ulcer of foot, Ulcer foot, Foot Ulcer [Disease/Finding], foot ulcers, foot ulceration, of foot ulcer, foot ulcerations, ulcer foot, Foot--Ulcers, Ulcus cruris, Foot ulcer, Ulcer of foot, Ulcer of foot (disorder), foot; ulcer, ulcer; foot, Ulcer of foot, NOS |
| Dutch | ulcus cruris, zweer aan voet, voetzweer, ulcus; voet, voet; ulcus, Ulcus, voet-, Voetulcus |
| French | Ulcus cruris, Ulcère du pied |
| German | Ulkus Fuss, Fussulkus, Ulcus cruris, Fußgeschwür |
| Portuguese | Úlcera crural, Úlcera do pé, Úlcera do Pé |
| Spanish | Úlcera en el pie, Úlcera de pie, Úlcera crural, úlcera del pie (trastorno), úlcera del pie, Úlcera del Pie |
| Japanese | 足の潰瘍, ｱｼﾉｶｲﾖｳ, 下腿潰瘍, ｶﾀｲｶｲﾖｳ |
| Swedish | Fotsår |
| Czech | noha - vředy, Vřed nohy, Bércový vřed |
| Finnish | Jalan haavauma |
| Russian | STOPY IAZVA, PODOSHVY STOPY IAZVA, ПОДОШВЫ СТОПЫ ЯЗВА, СТОПЫ ЯЗВА |
| Croatian | Not Translated[Foot Ulcer] |
| Polish | Owrzodzenie stóp |
| Hungarian | Ulcus cruris, Lábfekély, Fekély, láb |
| Norwegian | Fotsår, Sår på foten |
| Italian | Ulcera del piede |
