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Current Standards in Care of the Diabetic Foot
Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine
A Wednesday afternoon session on critical limb ischemia wounds included a presentation by Stephanie C. Wu, DPM, MSc, FACFAS, from Rosalind Franklin University, entitled “Current Standards in Care of the Diabetic Foot.” Dr Wu began by discussing 3 practical questions that clinicians should ask themselves when treating a patient with a diabetic foot ulcer (DFU): What am I going to take off the wound that may enhance healing? What can I use that may further enhance healing or mitigate infection? What can I do to prevent recurrence?
Dr Wu indicated that 2 things must be removed to heal a DFU: necrotic tissue (via debridement) and physical trauma (via offloading devices). She then reviewed ground reaction forces (vertical, anteroposterior, and mid-lateral) as well as shear force, and how they affect DFUs.
Taking a closer look at debridement, Dr Wu indicated that it is a key initial first step when treating DFUs, and optimum debridement should achieve a balance between the removal of necrotic tissue and preservation of healthy tissue. It should not inhibit subsequent healing. She also described how offloading devices work and presented the offloading capacity of different modalities.
Dr Wu emphasized the importance of compliance in offloading, noting that an initial removable cast walker (RCW) study found that only 28% of daily steps were taken with an RCW. Discussing surgical offloading, she spoke of an International Working Group on the Diabetic Foot systematic review in 2023, which found that foot surgery effectively reduced the risk of recurrent DFUs and was relatively more effective in preventing ulcer recurrence than healing an active foot ulcer.
In conclusion, Dr Wu reviewed additional considerations, such as moist wound healing and exudate control using advanced wound healing products, management of systemic and local factors, patient education (including glycemic control), adequate vascularity, bioburden/infection control, nutrition, and early recognition and treatment.
