Management of Diabetic Foot Ulcers
Management of Diabetic Foot Ulcers
DETERMINE CAUSES
e.g. Ill fitting shoes
CLINICAL GRADING (e.g. University of Texas grading system)
A - D: No infections or ischaemia (A), Infections (B), Ischaemia (C), Both (D).
0 - III: Epithelialized (0), Superficial (I), penetrates to tendon or capsule (II), penetrates to bone or joint (III).
ULCER TREATMENT
Relief of Pressure
- Non weight bearing is essential
- Mechanical unloading
Restoration of Skin Perfusion
- Arterial revascularisation procedures if required
- Treat smoking, hypertension and dyslipidemia
Treatment of infection
Superficial Ulcer
- Extensive debridement with removal of all necrotic tissue and oral antibiotics aimed at Staphylococci aureus and streptococci. No topical antibiotics
Deep (Limb-Threatening) infections
- Surgical drainage as soon as possible (emergency referral) with removal if necrotic or poorly vascularised tissue, including infected bone. Revascularisation if necessary. Broad-spectrum antibiotics intravenously aimed at Gram-positive and negative micro-organisms, including anaerobes
Metabolic Control and Treatment of Comorbidity
Optimal diabetes control, if necessary with insulin. Treat oedema and malnutrition
Local Wound Care
- Frequent wound inspection
- Frequent wound debridement
- Absorbent, non- adhesive, non- occulusive dressings
- Foot baths are contra-indications as they induce maceration of the skin
Instruction of Patient and Relatives
Appropriate self- care and recognition, as well as reporting of signs and symptoms of (worsening) infection, such as fever, changes in local wound conditions or hyperglycemia
Determine the cause and preventing recurrence
Determine cause as ulceration is a recurrent disease. Prevent ulcers on contralateral foot and give heel protection during bed rest. Patient must be included in a comprehensive foot-care program with life-long observation