How are diabetic foot ulcers treated?

Updated: Oct 15, 2020
  • Author: Tanzim Khan, DPM; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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The management of diabetic foot ulcers requires offloading the wound, [6, 7] daily saline or similar dressings to provide a moist wound environment, [8] débridement when necessary, antibiotic therapy with or without surgical intervention if osteomyelitis or soft tissue infection is present, [9, 10] optimal control of blood glucose, and evaluation and correction of peripheral arterial insufficiency. [11]

To promote ulcer healing in a person with diabetes and a neuropathic plantar ulcer, consider, if nonsurgical offloading therapy is unsuccessful, Achilles tendon lengthening, metatarsal head resection(s), or joint arthroplasty.

Wound coverage by cultured human cells [40, 43] or biologic skin substitutes, application of recombinant growth factors, [44, 45, 46, 47] and hyperbaric oxygen treatments also may be beneficial at times, but only if arterial insufficiency is not present.

Physicians of diabetic patients with ulcers must decide between the sometimes conflicting options of (1) performing invasive procedures (eg, soft tissue and musculoskeletal reconstruction, angiography, bypass surgery) for limb salvage and (2) avoiding the risks of unnecessarily aggressive management in these patients, who may have significant cardiac risk. In general, the greatest legal risks are associated with delay in diagnosis of ischemia associated with diabetic ulceration, failure to aggressively debride and treat infection, and failure to treat the wound carefully.

If a patient presents with a new diabetic foot ulcer, he or she should receive care from a multidisciplinary team of physicians, surgeons, podiatrists, and pedorthotists who have an active interest in this complex problem.

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