Ask the Treatment Expert about ... diabetic foot ulcers

Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC
Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC

What is the role of our clinicians in treating foot ulcers associated with a diagnosis of diabetes?

Almost 10% of Americans have a medical diagnosis of diabetes. Skilled nursing facility residents with diabetes require additional clinical assessments and interventions in order to prevent and treat its effects, including foot ulcers.

It is helpful for clinicians to understand the etiology of foot injuries. Some injuries are caused primarily by low pressure over a long period of time, while others can result from moderate, weight-bearing pressure. Single, high-pressure piercing events, such as a puncture wound or traumatic force, also can result in foot ulceration in the diabetic.

Prevention of foot trauma should be the clinician's primary focus. An initial foot examination or assessment followed by periodic examination is essential. This should include testing for peripheral neuropathy; monofilament testing using the Semmes-Weinstein test is the recommended process. The findings of the assessment should be documented in the resident's medical record. Individualized education about the assessment findings should be provided to the resident, family and staff. If the resident is at high risk for a foot ulcer, a physician's order for customized therapeutic shoes should be requested. 

Wound care, off-loading and infection detection and treatment are interventions necessary for diabetic residents identified with a foot ulcer. Frequent evaluation of the wound is necessary, along with off-loading pressure.

The physician should be consulted for debridement if callus or devitalized tissue is present. If the ulcer does not improve in four weeks, negative-pressure wound therapy should be initiated. 

Of course, monitoring and management of glucose is of the utmost importance for both prevention and treatment of foot ulcers in residents with diabetes.