Diabetic Foot Ulcers

Description 

Diagnosis

General Measures

Medicine Treatment 

Referral 

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ICD-10 Code: L97/L08.8 + (E10.5/E11.5/E12.5/E13.5/E14.5)

DESCRIPTION

• Ulcers develop at the tips of the toes and on the plantar surfaces of the metatarsal heads and are often preceded by callus formation
• If the callus is not removed then haemorrhage and tissue necrosis occurs below the plaque of callus which leads to ulceration. Ulcers can be secondarily infected by staphylococci, streptococci, coliforms, and anaerobic bacteria which can lead to cellulitis, abscess formation, gangrene, and osteomyelitis

DIAGNOSIS

The three main factors that lead to tissue necrosis in the diabetic foot are:

• Neuropathy
• Infection and
• Ischaemia

GENERAL MEASURES

• Metabolic control
• Treat underlying comorbidity
• Relieve pressure: non-weight bearing is essential
• Smoking cessation is essential
• Frequent (e.g. weekly) removal of excess keratin by a chiropodist with a scalpel blade to expose the floor of the ulcer and allow efficient drainage of the lesion
• Cleanse with sodium chloride 0.9% solution daily and apply non-adherent dressing

MEDICINE TREATMENT

• Amoxicillin/ clavulanic acid 875/125 mg oral 12 hourly for 10 days

Severe penicillin allergy: 
ICD-10 Code: Z88.0

• Refer

REFERRAL

Urgent

Threatened limb, i.e. if the ulcer is associated with:

• Cellulitis
• Severe hyperglycaemia
• Abscess
• Discolouration of surrounding skin, or
• Crepitus

Non-urgent

• Claudication
• Ulcers not responding to adequate treatment
• Severe penicillin allergy

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, 2024 Edition