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How to manage diabetic foot ulcers

How to manage diabetic foot ulcers

In this section, you’ll learn about:

A holistic approach to caring for diabetic foot ulcers

As a healthcare professional, you know that providing effective care is about more than just treating the patient in front of you. It’s a partnership between your patient, their family or relatives, and yourself and the rest of the healthcare team.

This is especially important when managing diabetic foot ulcers. It’s important to keep everyone informed about the patient’s treatment and care. This will help them to participate in decision-making, understand why you make certain clinical decisions, and support the patient in maintaining good self-care.1

In this section, we show you how to take a holistic approach to assessing and managing diabetic foot ulcers.

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How do I assess and monitor a diabetic foot ulcer?

One of the most effective ways to assess a DFU is to conduct a holistic wound assessment. If you don’t already know what this involves, you’ll find a full description here.

Once you’ve conducted a holistic assessment of the wound, here are some tips for how to monitor the patient’s wound over time:

  1. Establish a baseline. Record the size, depth, appearance and location of the DFU. This information will help you to develop a treatment plan and monitor how the wound responds to the agreed care plan.

  2. Document the DFU. Try taking a digital photograph of the DFU during the first consultation. Then take additional photographs periodically throughout the treatment. This will help you to track the wound’s progress over time. You can also use the photographs to give patients tangible proof that the wound is improving. And you can share the photographs with the rest of the healthcare team to make sure you’re all providing consistent wound care.

  3. Assess the area around the wound. Look for signs of erythema and maceration, as this might indicate complications that will prevent the wound from healing.1

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4 Essential steps to manage a diabetic foot ulcer

There are four essential steps to go through when managing diabetic foot ulcers:1,2

1. Pressure offloading

Neuropathy often leads to increased pressure on the sole of the foot, which can lead to diabetic foot ulcer formation. For this reason, reducing or offloading the pressure on the foot is the most important intervention to effectively heal a diabetic foot ulcer.3

2. Ensuring adequate blood supply

This step will help prevent acute limb ischaemia, or lack of blood in the limb. This is important because acute ischaemia is a clinical emergency and may put the patient at great risk if not managed in a timely and effective way.1

3. Administering local wound care

This step should include:

  • radical and repeated debridement;
  • frequent inspection and infection control; and
  • careful moisture balance to prevent maceration.1

4. Treating the underlying disease

As diabetic foot ulcers are a complication to diabetes, effectively managing them includes treating the underlying disease. So, when you examine your patient, you should look for signs of severe ischaemia, unstable diabetes or physical trauma.1

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How to select the right wound dressing

Choosing the right wound dressing is important to optimise healing and improve your patient’s wellbeing.

To choose a dressing, follow the checklist below:4, 1

The dressing should:

  • stay intact and remain in place.
  • prevent leakage.
  • reduce pain.
  • reduce odour.
  • retain exudate & fluid.
  • conform to the wound bed.
  • be comfortable.
  • work with an offloading device / footwear.
  • be easy to apply & remove.
  • be cost-effective.

The dressing shouldn't:

  • cause maceration, allergies or sensitivity.
  • damage the skin or wound bed when it’s removed.
  • cause further lesions.

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How to manage exudate in diabetic foot ulcers

One of the important factors to establish before selecting a topical treatment for diabetic foot ulcers is the wound’s level of exudate.4

If you have a diabetic foot ulcer with high exudate levels, you need a dressing that absorbs moisture. But if you have a dry wound, you will need to use a topical treatment that adds moisture.2

You can use the following guide, developed by World Union of Wound Healing Societies, to find the right dressing for the wound’s exudate levels.4

If you have a wound with high levels of slough and exudate choose a dressing that balances mositure and prevents periwound maceration.

TIP: A silicone foam or foam dressing should be able to absorb and retain exudate under pressure.

If you have a wound with low levels exudate choose a dressing that increases wound moisture to aid autolysis.

TIP: Try a silicone foam or foam dressing, or a high water-content dressing such as hydrogel.

If you have a wound with dep cavities choose a dressing that elimates dead space, or the gap between the wound bed and the dressing.

TIP: If the wound is very deep, you should pack it with a filler to make sure there is contact with the wound bed.

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References

View references
  1. Price, P. (2004). The Diabetic Foot: Quality of Life. Clinical Infectious Diseases. 39, 129–31.
  2. Raghav, A., Ahmad Khan, Z., Kumar Labala, R., Ahmad, J., Noor, S., Kumar Mishra, B. (2019). Financial burden of diabetic foot ulcers to world: a progressive topic to discuss always. Ther Adv Endocrinol Metab. 9(1) 29–31.
  3. Ahmad, A., Abujbaraa, M., Jaddouc, H., Younesd, N. A. (2018). Anxiety and Depression Among Adult Patients With Diabetic Foot: Prevalence and Associated Factors. J Clin Med Res. 10(5):411-418.
  4. Schaper, N. C., van Netten, J. J., Apelqvist, J., Bus, S. A., Hinchliffe, R. J., Lipsky, B. A. on behalf of the International Working Group on the Diabetic Foot (IWGDF) (2019). IWGDF Practical guidelines on the prevention and management of diabetic foot disease.
  5. International Diabetes Federation (2017). Clinical Practice Recommendation on the Diabetic Foot: A guide for health care professionals: International Diabetes Federation: Brussels
  6. National Institute for Health and Care Excellence (NICE) (2015). Diabetic foot problems: Prevention and management.
  7. Pendsey, S. P. (2010). Understanding diabetic foot. Int J Diabetes Dev Ctries. Apr-Jun; 30(2): 75–79.
  8. Tawfik, M. (2017). Peripheral arterial disease and the diabetic foot. Diabetic Foot Canada 5: 10–13.
  9. World Union of Wound Healing Societies (WUWHS) (2016).  Florence Congress, Position Document. Local management of diabetic foot ulcers. Wounds International.
  10. Wounds International (2013). International Best Practice Guidelines: Wound Management in Diabetic Foot Ulcers.
  11. Dowsett, C., Protz, K., Drouard, M. and Harding, K. G. (2015). Triangle of Wound Assessment made easy. Wounds International, May.