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Ask the treatment expert
Ask the treatment expert
Is it a realistic care plan goal to heal a diabetic foot ulcer that has been present for two years? 

Yes. However, four key areas must be addressed for diabetic wound healing to occur: bacteria levels, pressure distribution, presence of callused and necrotic tissue; and glucose control.

One or more of the following signs and symptoms may represent high bacteria levels in the wound: measurable drainage in a fully granulated wound, abnormal odor, redness, edema, change in color of the wound bed, delayed healing, pain or tenderness, increase serous exudate, absent or abnormal granulation tissue.

The use of topical antibacterial dressings or ointments will help keep the bacteria levels under control. 
Offloading, the reduction of repetitive pressure and shear forces on the foot, may be the single most important and most neglected aspect of treating diabetic foot wounds.  Every unprotected step can literally tear the wound apart. Options for offloading include: custom orthotics, appropriately fitted shoes and socks, total contact casting, proper placement and size of wound dressing, custom shoe inserts, walkers or even temporary wheelchair use. 

Weekly sharp debridement with a scalpel and forceps is the technique of choice, where the surrounding callus, together with slough, is gently cut away. 

Elevated glucose levels create a negative effect on the wound healing process resulting in decreased oxygen to the wound, increased risk for infection, and damage to both blood vessels and nerves.
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