Diabetic foot ulcers: Keys to prompt, aggressive therapy

Appropriate foot care, preventive measures, and early intervention reduce the incidence of complications and lower extremity amputation in patients with diabetic foot ulcers. A thorough lower extremity examination includes assessment of the skin, interdigital areas, skin quality and integrity, and ulcerative or pre-ulcerative changes. Explore any wounds with a small, sterile blunt probe and record clinical signs of infection. If lower extremity pulses are diminished or absent, consult a vascular surgeon. Also assess sensory perceptions and deep-tendon reflexes. Diminution or loss of protective sensation increases the risk of ulceration. Structural deformities, such as hammer toes or Charcot neuroarthropathy, often create high-pressure areas that can ulcerate. Wound care entails debridement of necrotic, calloused, and fibrous tissue; the application of topical enzymes and special dressings; and treatment of underlying infection and ischemia. The key to prevention is patient education and lifelong commitment to self-care.