Diabetic Foot Ulcers

By Tedman L. Tan and James McGuire DPM, PT, CPed, FAPWHc

The management of diabetic foot ulcers is becoming an increasingly significant concern with the growing population of patients with diabetes in the United States. Most amputations involving the lower extremity in patients with diabetes are preceded by foot ulcers, and in turn, lower extremity amputations are associated with a high 5-year mortality rate at around 45% among individuals with diabetes.¹ Therefore, diabetic foot ulcers require special attention due to the possible life-threatening complications associated with such wounds

By the WoundSource Editors

The term diabetic foot refers generally to the increased occurrence of complications in the feet of patients with diabetes mellitus. The most common foot problems related to diabetes are peripheral neuropathy leading to ulceration, vascular disease, increased risk of infection, and deformities like Charcot arthropathy. Complications arising from diabetes are the most common non-traumatic injury to cause lower extremity amputation.

By Michel H.E. Hermans, MD

The CDC recently published encouraging data in the New England Journal of Medicine about a decline in the rate of five major complications related to diabetes mellitus: hyperglycemia, heart attack, stroke, kidney failure and amputations¹. The report did not include eye-related problems (i.e. retinopathy, glaucoma, cataract). The rate of amputations went down from approx. +/- 55/10.000 adults (1990) to +/-26/10.000 adults (2010). The 2010 numbers on amputations are roughly in line with a more recent publication by the Agency for Healthcare Research and Quality (AHRQ) which reported an expected (2014) amputation rate of 3.75/person-year for type II and 3.8 for type I (figure I).

By Aletha Tippett MD

Many have never heard of diabetic foot complications Charcot foot, or at least don't know what it is. If you care for individuals with diabetes who have neuropathy, you almost certainly will see Charcot foot. My patients with Charcot have told me they have a disease of the foot "with crumbling bones." This is actually fairly accurate. Charcot is a neuropathic bone disease that causes osteoporosis-type destruction of the bones in the foot. As a result of this, the bones shift and move and break.

By Dr. Mark Hinkes, DPM

After you've checked vital signs – pulse, respiration, blood pressure and temperature – don't forget what's considered to be the fifth vital sign: PAIN. For patients with diabetes, one of the most challenging health problems is foot pain. Diabetic sensory neuropathy is the most commonly associated reason for foot pain in the patient with diabetes. However, there can be multiple and even overlapping etiologies that should be identified and evaluated before jumping to a conclusion.

By Dr. Mark Hinkes, DPM

Twenty first century technology is helping people with diabetes to heal foot ulcers. An Australian colleague, for example, is developing an application that reminds people with diabetes to control their blood sugars with prompts and instructions, and allows them to upload a picture of their wound for their podiatrist to evaluate.

By Margaret Heale, RN, MSc, CWOCN

I have been living with my daughter for almost a year and helping out at a nursing home where my granddaughter works. I don't remember having this problem last year but my skin is just on fire at times, itchy, itchy, itchy! I found a cream but ran out and couldn't remember what it was called. When I got to the pharmacy and told the lady there that I was in search of a product whose name I thought sounded like 'Narnia' she pointed me in the right direction. Then, to my surprise, she added, "but remember not to go through the wardrobe door or you might get more than you bargained for." We laughed so much I remembered I best go to the feminine hygiene section. I just wanted a slim little pad, you know for the odd cough or sneeze, but—ohhh—what a choice!

By Lydia A Meyers RN, MSN, CWCN

Hyperbaric Oxygen Therapy (HBOT) is a type of therapy that is oxygen done under greater than atmospheric pressure. Treatments are done according to approval by Medicare/Medicaid rules and regulations. At this time HBOT has been approved for the following:

By Christine Shettel, RN, BSN, WCC, DAPWCA, PWRC

Hyperbaric medicine has been used in wound care for over 50 years. As wound care professionals, we are saving patient’s lives, and preserving limbs utilizing Hyperbaric Oxygen Therapy (HBO). As health care professionals we understand the indications and benefits of HBO therapy, however, it’s important to follow clinical pathways and your local coverage determinations to ensure that we are placing the clinically appropriate patients in the chambers. It’s also important to understand what clinical documentation is required in order to qualify your patients for treatments to achieve optimal outcomes.

By Aletha Tippett MD

In considering this question as to whether amputation can be palliative, let’s keep clear that these are two separate subjects that sometimes interact. It is key to always keep our goals in mind. What is the goal in palliative care? The goals are to provide comfort, relieve pain, prevent infection, and improve or maintain quality of life. These goals are always to be in concert with the desires and wishes of the individual patient.