Australian Diabetes Foot Network: management of diabetes‐related foot ulceration — a clinical update

Abstract

Appropriate assessment and management of diabetes-related foot ulcers (DRFUs) is essential to reduce amputation risk. Management requires debridement, wound dressing, pressure off-loading, good glycaemic control and potentially antibiotic therapy and vascular intervention. As a minimum, all DRFUs should be managed by a doctor and a podiatrist and/or wound care nurse. Health professionals unable to provide appropriate care for people with DRFUs should promptly refer individuals to professionals with the requisite knowledge and skills. Indicators for immediate referral to an emergency department or multidisciplinary foot care team (MFCT) include gangrene, limb-threatening ischaemia, deep ulcers (bone, joint or tendon in the wound base), ascending cellulitis, systemic symptoms of infection and abscesses. Referral to an MFCT should occur if there is lack of wound progress after 4 weeks of appropriate treatment.

Comparison of healing rate in diabetes‐related foot ulcers with low frequency ultrasonic debridement versus non‐surgical sharps debridement: a randomised trial protocol

“…Debridement has been defined as the removal of devitalised, contaminated or foreign material from within or adjacent to the ulcer until surrounding healthy tissue is exposed [10]. It serves several functions including reduced pressure on the ulcer base, more thorough inspection to determine true ulcer depth and size, facilitation of drainage and creation of an acute ulcer environment [6]. …”

A survey of offloading practices for diabetes-related plantar neuropathic foot ulcers

“…There is evidence that such devices heal a significantly higher proportion of ulcers and also lead to faster healing [6,7], but the use of these devices is not high, suggesting that there are important barriers to their use in everyday practice [8][9][10]. Where these interventions are not available, or if they are deemed inappropriate, 'other' offloading modalities should be considered, including: post-operative shoes, felt padding, half-shoes and cast-shoes [11][12][13]. However, the evidence for the effectiveness of 'other' offloading modalities for ulcer healing is limited [12].…”

Bacteriocin from Bacillus subtilis as a novel drug against diabetic foot ulcer bacterial pathogens

“…Approximately half of the additional mortalities were due to cardiovascular disease, such as heart attack or stroke [1] . Mostly these diabetes related foot ulcers occur in the presence of peripheral sensory neuropathy, foot deformity and/or trauma, with peripheral arterial disease and infection being further complicating factors that prevent or delay ulcer healing [2] . Most often these ulcers are polymicrobial.…”