Foot & Ankle Institute

Monday, January 05th, 2009

Wound Grade Category (Ulcer Present)

Foot Risk Category | Wound Grade Category

Treatment of Diabetic Ulcers

Foot ulcers are a major cause of morbidity, mortality, and disability in people with diabetes. In the presence of Neuropably, and/or Ischmia, the sequence of minor trauma leading to cutaneous ulceration a wound healing failure is a frequent cause of lower extremity amputations.

Prompt and proper care of diabetic foor ulcer is essential. The health care professional should include the following in treating the Diabetic Foot Ulcer.

1) Evaluation of Ulcer	Etiology Size of Ulcer Depth Involvment of deep structures
2) Classify the Ulcer	Localized
3) Rule Out Infection	Purulent Exudate Necrosis Sinus Tracts Odor Edema Cellulitis Absess Fluctuation
4) Rule Out Systemic Infection	Temperature Fever, Chills
5) Radiological Exam	A radiological exam should be performed to exclude subcutaneous gas, presence of a foreign body, Osteomyelitis , an Charcot's Foot. Plain Radiographs: may demonstrate periosteal resorption and osteolysis Bone Scan: 3 phase scan may be necessary to differentiate osteomylitis from Charcot's Foot.
6) Bacterial Cultures	Cultures by swab technique may be misleading since the bacterial infection of foot lesions are commonly polymicrobial .
7) Antibiotics	If infection is suspected, broad spectrum antibiotics coverage should be initiated immediately and modified as necessary based on culture results.
8) Wound Care
9) Metabolic Control	Infection and / or inflammation may result with widely fluctuating blood glucose levels. Hyperglycemia may result in a decreased ability to fight infection, therefore, good control of blood glucose should be a primary goal of the patient's total care.
10) Determine Vascular Status
11) Off-Loading