Help Notes for Nurses No. 6 Managing Diabetic Foot Ulcers

What is the prevalence of diabetes-related foot ulceration?

In its 2013 “Best Practice Guidelines: Wound Management in Diabetic Foot Ulcers", Wounds International of England, which convened expert and review groups of physicians from 9 countries, recounts estimates that in the UK 5% to 7% of diabetics had foot ulcers. Over their lifetime, 25% of diabetics would develop foot ulcers.

Whereas the annual incidence of foot ulcers is about 2%, some 50% of older patients with type 2 diabetes are at significant risk of foot ulceration.

What are the costs of diabetic foot ulcers?

In the Wounds International report cited above, it is reported that one case of diabetic foot ulcers tends to cost more than $25,000 over a two-year period in the USA. In the U.K., 20% the National Health Service expenditure on diabetes is attributable to foot complications.

What management strategies have been recommended?

In "Comprehensive Foot Examination and Risk Assessment", Dr. Andrew J.M. Boulton and a large team of medical colleagues recommend screening tools that would carry out: general inspection, dermatological assessment, neurological assessment, vascular assessment, and testing of pinprick sensation, ankle reflexes, and vibration perception threshold.

At a recent World Congress on Dermatology, Dr. Afsaneh Alavi, University of Toronto dermatologist, advocated debridement to remove the callous, as well as use of the total contact cast and the removable cast walker. She also advised the use of therapeutic shoes and insoles, active self-inspection, and resort to professional foot care. "Shoes should be worn at all times, even in the house."

"Diabetic Ulcers Treatment & Management" is the title of a comprehensive survey published in September 2015 by a team of doctors lead by Vincent Lopez Rowe, MD, and Romesh Khardori. They state: "The management of diabetic foot ulcers requires offloading the wound by using appropriate therapeutic footwear, daily saline or similar dressings to provide a moist wound environment, debridement when necessary, antibiotic therapy if osteomyelitis or cellulitis is present, optimal control of blood glucose, and evaluation and correction of peripheral arterial insufficiency.

Wound coverage by cultured human cells or heterogeneic dressings/grafts, application of recombinant growth factors, and hyperbaric oxygen treatments also may be beneficial at times, but only if arterial insufficiency is not present." The text goes on to provide detailed procedures under the following topics: wound and foot care, vacuum-assisted closure, hydrotherapy, and treatment of Charcot foot.

References

Afsaneh Alavi, MD, FRCPC, and others. Diabetic foot ulcers : Part II. Management. Journal of the American Academy of Dermatology, Volume 70, Issue 1, January 2014, Pages 21.e1–21.e24

Andrew J.M. Boulton, MD, FRCP, and others. Comprehensive Foot Examination and Risk Assessment. A report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care. 2008 Aug; 31(8): 1679–1685.

doi: 10.2337/dc08-9021.

Rhiannon L. Harries, Keith G. Harding. Management of Diabetic Foot Ulcers. Dermatology And Wound Care: Current Geriatrics Reports. September 2015, Volume 4, Issue 3, pp 265-276. 03 May 2015.

Bruce Jancin. Offloading is key to diabetic foot ulcer management. August 22, 2015. www.clinicalendocrinologynews.com—90500dadbd0457b42753ed050a156ce2.html

Vincent Lopez Rowe, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP. Diabetic Ulcers Treatment & Management. Sep 08, 2015. emedicine.medscape.com—460282-treatment .

Wounds International. International Best Practice Guidelines: Wound management in diabetic foot ulcers.

International Best Practice Guidelines: Wound Management in Diabetic Foot Ulcers. Wounds International, 2013. Available from: www. woundsinternational.com .

Managing Diabetic Foot Ulcers

by Foot Care Academy

(1-416-272-3859, register@footcareacademy.ca)

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