Ask the Treatment Expert ... Diabetic foot ulcers

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

Can you help us improve treatment of diabetic foot ulcers?

Diabetic foot ulcers usually are located on weight-bearing plantar surfaces, the medial surface of the metatarsophalangeal joint, the lateral aspect of the fifth metatarsophalangeal joint, or the tips of the toes.

The wounds have the following characteristics:

• Tissue in the wound bed is usually pale pink or yellow.

• Wound margins are even.

• Wound is usually located over a bony prominence.

• Wound may or may not be surrounded by callus.

• Exudate is minimal.

Preventive comprehensive foot assessments and foot screenings, conducted annually, are an essential component of care for all residents with a diagnosis of diabetes.  

It is very important to provide a management program that treats the underlying disease process, addresses factors to promote blood flow, offloads pressure-affected areas, and provides infection prevention.

Treatment of a diabetic wound begins with interventions to control blood sugar or glucose levels. An A1C level of 7.0 or below should be maintained. Because the inflammatory process is delayed in individuals with diabetes, the typical signs and symptoms of infection are frequently absent. Therefore, it is very important to debride necrotic tissue from diabetic foot ulcers. Frequent sharp debridement is the gold standard for tissue management.

Measures should be initiated to provide offloading of all mechanical stress from the wound. These may include bed rest, orthopedic insoles or shoes, walking splints or total contact casts. Wound dressings should provide moist wound healing. Consult the wound specialist, physical therapist or physician for specific instructions.