Diabetic Foot Ulcers

Thomas Serena's picture

By Thomas E. Serena MD, FACS, FACHM, FAPWCA

I had the honor of lecturing to an audience of mostly European physicians at the M.I.L.A.N. Diabetic Foot Conference this past February in Milan, Italy. My session this year focused on our current and ongoing research in point-of-care diagnostics. To date, we have enrolled more than a thousand patients in a dozen clinics across the United States. All of these trials led to the development of the first commercially available wound diagnostic, WOUNDCHEK (Systagenix, Gargarve, UK), approved in Europe last year (it has not yet received FDA clearance for use in the US). A revolutionary product, I imagined that it would have received rapid, wide-spread acceptance among my European colleagues. At the end of the presentation I asked for a show of hands: “How many of you are using the test in your clinics or hospitals.” In an audience of nearly one hundred, only three attendees raised their hands.

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David Hite's picture

By David Hite PhD

Diabetes, the leading cause of amputation of the lower limbs, places an enormous burden on both the individual and the health care system. It’s estimated that the annual cost for treating diabetic foot problems is over one billion dollars. During their lifetime, 15 percent of people with diabetes will experience a foot ulcer and about 20 percent of those will require amputation.

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Kim Coy Decoste's picture

By Kim Coy DeCoste RN, MSN, CDE

It can be quite concerning when you ask your patients attending a DSME class “How many of you have had your feet checked for blood flow and nerve function by your health care provider?”, and far less than half of them raise their hands. Probing a little further, you find that a number of patients have never even had their feet visually inspected by their health care provider (HCP) for signs of diabetic foot ulcers. This isn’t unique to my practice site. Recently when I was teaching a professional education program with diabetes educators from across the US, most in the group concurred with my findings.

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Laurie Swezey's picture

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Diabetic foot ulcers are one of the most dreaded complications of diabetes, and represent a significant cause of morbidity and mortality. It is estimated that a lower limb is sacrificed every 30 seconds somewhere in the world due to diabetes, and that diabetes is the reason for almost 50% of non-traumatic amputations of the lower leg throughout the world. Considering these facts, proper management of diabetic foot ulcers is of paramount importance.

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Michael Miller's picture

By Michael Miller DO, FACOS, FAPWCA


I just had the most amazing thing happen: I received a letter from my hospital informing me that they were considering creating an Open-Heart Surgery Center. Other than myself, there will be Radiologists, Family Practitioners, and Pathologists all participating in the program. In an effort to share the proceeds from participating in this venture, all participants will be offered four hour time periods throughout the week in which to practice this new specialty. Recognizing that we are not experts in this area of medicine, each of us will be required to take a one-week course in open-heart surgery before being able to hang our shingles outside the clinic.

Thomas Serena's picture

By Thomas E. Serena MD, FACS, FACHM, FAPWCA

One of the greatest honors of my life was being inducted into the Athletic Hall of Fame at The College of William and Mary. I was a gymnast there during my college days, a sport I chose early in life. My first loves were basketball and football, but I was always either too small or too light to play these sports competitively for my school teams. Even on the playground I was frequently chosen last in basketball pick-up games. To this day I remain sensitive to team picking. I recently received a call from a physical therapist looking to join my wound care team. Her hospital had enlisted the services of a management company that had marginalized the role of physical therapy in the outpatient wound care center.

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Aletha Tippett MD's picture

By Aletha Tippett MD

Every six minutes, somewhere in the United States, someone loses a limb due to amputation because of peripheral neuropathy. Neuropathy can cause pain, balance problems, loss of dexterity, and loss of sensation, all of which can lead to foot ulcers.

Diane Krasner's picture

From The Clinical Editor

By Diane Krasner PhD, RN, CWCN, CWS, MAPWCA, FAAN


The push towards safety by regulators and payers reflects the evidence that safe healthcare practices have numerous benefits – from reducing sentinel events to improving quality outcomes and helping to avoid litigation (1, 2, 3, 4). The wound care community has been slow to adopt the safety mantra . . . but the time has come to put your “safety lenses” on and to view wound prevention and treatment as a safety issue.

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WoundSource Editors's picture

By the WoundSource Editors

Neuropathic ulcers form as a result of peripheral neuropathy, typically in diabetic patients. Local paresthesias, or lack of sensation, over pressure points on the foot leads to extended microtrauma, breakdown of overlying tissue, and eventual ulceration. In addition, neuropathy can result in minor scrapes or cuts failing to be properly treated and eventually developing into ulcers.

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