II. Pathophysiology

  1. Sensory protection is lost
    1. Results in chronic Trauma
    2. Tissue breaks down in Traumatized area
    3. Charcot changes result in additional pressure points
  2. Complicating factors
    1. Peripheral Vascular Disease
    2. Osteomyelitis

III. Evaluation: General

  1. Assess for Osteomyelitis
  2. Assess for foreign body
  3. Assess for Peripheral Vascular Disease

IV. Evaluation: Inpatient Criteria for Foot Wound with Limb-Threatening Infection

  1. Extensive Cellulitis (>2 cm)
  2. Ascending lymphangitis
  3. Deep abcesses
  4. Osteomyelits
  5. Gangrene
  6. Critical Limb Ischemia
  7. Probe extends to bone (probe to bone test)
  8. Frykberg (2006) J Foot Ankle Surg 45(5 Suppl):S1-66 [PubMed]

V. Management: Outpatient

  1. Offloading is key
    1. Ongoing Trauma persists until non-weight bearing
    2. Options
      1. Use Crutches, walker or wheelchair
      2. Darko Shoe (half shoe not offloads distal foot)
      3. CAM Walker or cast
  2. Dressings (moist healing is critical)
    1. Dry to minimal exudates
      1. Wet-to-Moist Dressing (cost effective, first line) or other Saline Gauze Dressing
      2. Hydrogel Dressing (e.g. Curasol)
    2. Moderate to heavy exudates
      1. Hydrofiber dressing (e.g. Aquacel)
    3. Other preparations with specific indications
      1. Silver products (e.g. Acticoat) may be considered for infected wounds
      2. Debridement salves (e.g. accuzyme) may be considered for Enzymatic Debridement
    4. Other more complex and expensive options
      1. Promogran
      2. Becaplermin (Regranex)
      3. Bioengineered skin graft
  3. Additional measures
    1. Determine if antibiotics are appropriate
    2. Remove Callus (causes pressure areas)

VI. References

  1. (2014) Presc Lett 21(12): 71

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Ontology: Diabetic foot ulcer (C1456868)

Concepts Disease or Syndrome (T047)
MSH D017719
SnomedCT 371087003
LNC LP98442-4, MTHU029695, MTHU035222
Dutch diabetische voetzweer
French Mal perforant plantaire, Ulcère diabétique du pied, Ulcère du pied diabétique
German diabetisches Fussulkus, Fußulkus, diabetisches
Italian Ulcera di piede diabetico, Ulcera del piede diabetico
Portuguese Úlcera do pé diabética, Úlcera Diabética do Pé
Spanish Úlcera en pie diabético, Úlcera de Pie Diabético, úlcera pédica diabética (trastorno), úlcera pédica diabética
Japanese 糖尿病性足部潰瘍, トウニョウビョウセイソクブカイヨウ
Czech Diabetická noha s vředem, diabetický vřed
Hungarian Diabeteses láb fekély
English Diabetic foot ulcer, diabetic foot ulcer, diabetes mellitus foot ulcer, diabetes mellitus foot ulcer (diagnosis), Diabetic foot ulcer(s), Diabetic foot ulcers, Diabetic foot ulcer (disorder), Foot Ulcer, Diabetic
Norwegian Diabetiske fotsår