J Korean Foot Ankle Soc.  2014 Mar;18(1):1-7. 10.14193/jkfas.2014.18.1.1.

Management of Diabetic Foot Ulcer

• Seo DK
• Lee HS

• KMID: 1958731
• DOI: http://doi.org/10.14193/jkfas.2014.18.1.1

Abstract

In patients with diabetic foot, ulceration and amputation are the most serious consequences and can lead to morbidity and disability. Peripheral arterial sclerosis, peripheral neuropathy, and foot deformities are major causes of foot problems. Foot deformities, following autonomic and motor neuropathy, lead to development of over-pressured focal lesions causing the diabetic foot to be easily injured within the shoe while walking. Wound healing in these patients can be difficult due to impaired phagocytic activity, malnutrition, and ischemia. Correction of deformity or shoe modification to relieve the pressure of over-pressured points is necessary for ulcer management. Application of selective dressings that allow a moist environment following complete debridement of the necrotic tissue is mandatory. In the case of a large soft tissue defect, performance of a wound coverage procedure by either a distant flap operation or a skin graft is necessary. Patients with a Charcot joint should be stabilized and consolidated into a plantigrade foot. The bony prominence of a Charcot foot can be corrected by a bumpectomy in order to prevent ulceration. The most effective management of the diabetic foot is ulcer prevention: controlling blood sugar levels and neuropathic pain, smoking cessation, stretching exercises, frequent examination of the foot, and appropriate education regarding footwear.

Keyword

Diabetic foot ulcer; Treatment of ulcer; Off-loading procedure

MeSH Terms

Amputation
Arthropathy, Neurogenic
Bandages
Blood Glucose
Congenital Abnormalities
Debridement
Diabetic Foot*
Education
Exercise
Foot
Foot Deformities
Humans
Ischemia
Malnutrition
Neuralgia
Peripheral Nervous System Diseases
Sclerosis
Shoes
Skin
Smoking Cessation
Transplants
Ulcer*
Walking
Wound Healing
Wounds and Injuries
Blood Glucose

Figure

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  Figure 1. Intractable toe ulcers caused by toe deformities. (A) Hammer toes. (B) Toe tip ulcer. (C) Toe tip ulcer of right big toe caused by limitation of dorsiflexion (arrows). (D) Dorsal ulcer of overriding second hammer toe. (E) Medial ulcer of big toe of hallux valgus deformity (arrow).

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  Figure 2. Intractable plantar ulcer (A) due to bony prominence (B, arrow) in Charcot foot. (C) Bumpectomy of the bony prominence (arrow). (D) Completely healed ulcer after bumpectomy.

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  Figure 3. Chronic wound on the lateral side of right foot (A) with osteomyelitis of the fifth metatarsal base (B, arrow). (C) Healed chronic wound after complete debridement including resection of infected bone.

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  Figure 4. (A) Intractable plantar ulcer. (B, C) Plantar condylectomy was done. (D) Healed wound after condylectomy.

Reference

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