Management of Diabetic Foot Ulcer
Dong-Kyo Seo, Ho Seong Lee
Department of Orthopaedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
Correspondence to: Ho Seong Lee
Department of Orthopaedic Surgery, Asan Medical Center, Ulsan University
College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea
Tel: 82-2-3010-3536, Fax: 82-2-488-7877, E-mail: hosng@amc.seoul.kr
Department of Orthopaedic Surgery, Asan Medical Center, Ulsan University
College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea
Tel: 82-2-3010-3536, Fax: 82-2-488-7877, E-mail: hosng@amc.seoul.kr
Received January 23, 2014; Revised February 3, 2014; Accepted February 3, 2014.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
- 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.
- Keywords : Diabetic foot ulcer, Treatment of ulcer, Off-loading procedure
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