The Management of Diabetic Foot Ulcers

The Management of Diabetic Foot Ulcers

Introduction

This article discusses the importance of managing diabetic foot ulcers appropriately and the risks associated with poor management.

Foot ulcers are a patch of broken skin or open wound that commonly occur on the lower leg or bottom of the foot.

People with diabetes are more likely to develop foot ulcers due to vascular complications or peripheral diabetic neuropathy. This causes reduced nerve functioning, which means that the nerve signals do not function as normal, so the patient is not aware of the damage since the nerves do not communicate the pain sensation to the brain.

It is essential that people who have diabetes keep their blood glucose levels under control to reduce the risk of slow-healing wounds and complications, including foot ulcers. Low glucose levels directly correlate with slower wound healing.

Is it important for diabetic foot ulcers to be treated correctly and timely, as serious foot ulcers can become infected which can spread to the surrounding bones and muscles. This is called osteomyelitis. If the infection is left untreated, this can ultimately result in amputation.

Independent Recommendations to Improve Healthcare Standards and Patient Safety

I. Early recognition and regular wound assessments - Patients at risk of foot ulcers should have regular wound assessments carried out so that any deterioration can be quickly identified, and the care plan adjusted to the patient’s needs.

II. Record keeping - If a person has a diabetic foot ulcer, an assessment should be carried out and the size, depth and position of the ulcer should be recorded. This allows other clinicians to understand the patients’ clinical circumstances and to identify any deterioration/healing.

III. Referral to appropriate experts - For example Multidisciplinary foot team, Tissue Viability Nurse, Orthopaedics, Vascular Surgeon.

IV. Advice - Patients can be advised to wear pressure relieving footwear, to offload their feet/legs to promote healing. Furthermore, wound dressings should be applied and regularly changed to keep the ulcer clean and dry and aid with the healing process.

In summary, Trusts should ensure that they have an appropriate care pathway to ensure that healthcare professionals understand what to do when a diabetic foot ulcer is identified and that they provide timely care.

References

  • Co-written by The TMLEP Clinical Risk and Patient Safety Publishing Group and Ms Zoe Newark, TMLEP Analyst. (2021). The Management of Diabetic Foot Ulcers. TMLEP Clinical Risk Case Studies. 7 (9), 1.

Important Note

This article is intended to raise awareness to clinical risk issues in an effort to reduce incidence recurrence and improve patient safety. This is not intended to be relied upon as advice. Facts have been altered to ensure this case is non-identifiable, albeit clinical learning points remain applicable. To request an independent clinical review, please contact [email protected] or call +44 (0) 203 355 9796.