Pearls for Practice: Diabetic Foot Ulcer Management

     In a practice setting with a high incidence of diabetes and diabetic foot ulcers, patients often have numerous comorbidities. Utilizing best practice guidelines and building on our experience with our patient population, we use a multidisciplinary approach to address the underlying issues that have led to the client acquiring a wound.

     We perform a complete lower limb assessment and “60-second diabetic foot exam” along with a comprehensive client history. Concerns identified as a result of sensory testing are addressed through client teaching. A certified diabetic foot care nurse and chiropodist address any evidence of pressure (callous) and sheer (bruising, blood, blisters) and concerns related to development of Charcot foot. Infrared thermography scans are performed to identify areas of significant heat or coolness, followed by physician referral. Wounds are assessed for heat and signs of infection because diabetic wounds are often chronically overpopulated with bacteria and can deteriorate quickly. These wounds often present with much slough and eschar and subsequently require frequent debridement. Appropriate offloading is initiated.

     Because the diabetic wound can change status as quickly as the client’s blood sugar, ongoing and frequent assessments are required. Hb A1Cs are ordered and the clients referred to diabetic education for dietary consultations. Ensuring tight glycemic control improves wound healing and reduces the risk of developing additional complications. Clients are asked to log their blood sugars four times per day and the diabetic educator stays in frequent contact to ensure optimal glycemic control is maintained. Concerns related to poor diabetic outcomes including renal and cardiac issues involving kidney function, lipid status, blood pressure, and vascular flow are addressed by the family physician. Medications are reviewed to ensure they do not affect the wound status or blood sugar levels. Following this protocol has helped our client base have a healthy approach to their at-risk feet.

Pearls for Practice is made possible through the support of Ferris Mfg. Corp, Burr Ridge, IL (www.polymem.com). The opinions and statements of the clinicians providing Pearls for Practice are specific to the respective authors and are not necessarily those of Ferris Mfg. Corp., OWM, or HMP Communications.

This article was not subject to the Ostomy Wound Management peer-review process.