Diabetic Foot Ulcers

Robin Lenz and Fahad Hussain's picture

By Dr. Lenz and Dr. Hussain

Heel pressure injuries and various forms of ulcers are easy to identify, but are you overlooking sleeping position as a cause for wounds in other locations? Do you have a wound you are sure is venous but has normal venous insufficiency testing results and fails to respond to compression? Can pressure while sleeping slow or stop healing in your patients with venous and arterial wounds? Do you ask patients about their sleeping position in your history taking and physical examination? After reading this article, you will be able to ask patients about their sleeping habits and heal more wounds with that knowledge

WoundSource Editors's picture

By WoundSource Editors

Diabetic foot ulcers (DFUs) are open sores or wounds caused by a combination of factors that include neuropathy (lack of sensation), poor circulation, foot deformities, friction or pressure, trauma, and duration of diabetes with complication risks. DFUs occur in 34% of people with diabetes, and approximately 14% to 24 % of patients with diabetes who develop a DFU will require an amputation.

Liping Tang's picture

By Liping Tang, PhD

Infection is the single most likely cause of delayed healing in chronic wounds. In most cases, identification of chronic wound infection (e.g., diabetic foot ulcers and venous leg ulcers) is not obvious because chronic wounds do not exhibit the same classic inflammatory signs of infection as those found in acute wounds. More arduously, those common signs of infection—pain, erythema, heat, and purulent exudate— vary as we age and occur differently in those with underlying diseases or weakened immune systems. Diagnosis is generally based on the doctors’ experience and could be confirmed with microbiological culture of tissue biopsy. However, culture could take a few days, and the results may not always be reliable because of sampling error. A fast and accurate diagnosis of wound infection would relieve the patient of significant discomfort and improve the treatment outcome.

Holly Hovan's picture

Holly Hovan, MSN, GERO-BC, APRN, CWOCN-AP

Standards of care and evidence-based guidelines should lead our wound care practice to ensure the best possible outcomes for our patients. There are often prewritten algorithms or first- and second-line therapies, along with outlined treatment plans and guidelines established based on evidence. These guidelines can be adjusted to meet each patient’s specific needs.

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WoundSource Editors's picture

Diabetic foot ulcers (DFUs) may affect up to 25% of people with diabetes at some point in their lifetime. Once a person has developed a DFU, there is a 50% chance the ulcer will become infected. DFUs are also among the leading causes of amputation.

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Dianne Rudolph's picture

By Dianne Rudolph, DNP, GNP-bc, CWOCN

In evaluating a patient with a wound on the foot, a question that often comes to mind is whether that wound is caused by pressure, diabetes mellitus (DM), ischemia, trauma, or a combination. For example, a patient with DM who happens to have an ulcer on the foot may have a diabetic foot ulcer (DFU) or possibly something else. One of the bigger challenges that many clinicians face is trying to determine the etiology of a foot ulcer. There has been a great deal of debate about DFUs and pressure injuries (PIs) on the feet of patients in terms of how to appropriately assess, classify, and treat them. The confusion and lack of evidence in differentiating between these two types of foot ulcers, particularly on the heel, can lead to misdiagnosis, which can increase both financial and patient-related costs.

WoundSource Practice Accelerator's picture

Approximately 2 million people in the United States are living with limb loss, and this figure is expected to double by 2050. Lower-limb amputation accounts for the vast majority of all amputations, and diabetes—specifically, diabetic foot ulcers (DFUs)—is the leading cause of nontraumatic lower-limb amputations in the US. Although already high, the rate of amputation is increasing.

Temple University School of Podiatric Medicine's picture

By Temple University School of Podiatric Medicine Journal Review Club

A diabetic foot ulcer (DFU) is a wound that has a higher risk of becoming chronic, leading to amputation and, in some cases, even death. Currently, the Wagner and Texas classification are used worldwide to assess the extent of diabetic foot lesion. The authors of this article believe that there is a lack of wound treatment principles based on both classification systems. In the article, they have summarized the STAGE principles of wound treatment for clinical practice based on the Wagner and Texas classification system. The STAGE principle refers to surgical intervention during wound treatment of a DFU. With a focus on the anatomical layers of the wound, the management of blood supply, layer by layer incision to the infected area, maintenance of adequate wound drainage, and step by step treatment of the wound. STAGE is the management of an ulcer through its anatomical layers. Skeleton, Tendon, Angiogenesis, Granulation, and Epithelialization.

WoundSource Practice Accelerator's picture

Chronic wounds of the lower extremities impose an increasing burden on health care providers and systems, and they can have a devastating impact on patients and their families. These wounds include diabetic ulcers, venous ulcers, arterial ulcers, and pressure injuries. The estimated socioeconomic cost of chronic wounds is 2% to 4% of the health budget in Western countries. Moreover, patient mortality in individuals with chronic wounds has been estimated at 28% over a two-year period, significantly higher than the 4% mortality rate reported for 75 to 79 year-olds without chronic wounds.

WoundSource Practice Accelerator's picture

Chronic and complex wounds of the lower extremity frequently recur. It is difficult to determine the precise recurrence rate across patients with different lower extremity wound types, including diabetic foot ulcers, arterial ulcers, pressure injuries, and venous ulcers. However, we know that recurrence rates are high; nearly 40% of patients with an ulcer will develop a recurrence within one year of healing. This percentage is 60% at three years after healing and 65% at the five-year mark.