Treating the diabetic ulcer: practical approach and general concepts

Neuropathic foot disease is commonly seen in clinical practice and is related primarily to the high and increasing prevalence of diabetes mellitus in the western world. The treatment of diabetic ulcer can be divided into three stages: evaluation, healing, prevention. Based on the evaluation, foot ulceration in diabetic patients can be categorized as non-infected and infected. Non-infected and non-ischemic ulcers heal when the area is off-loaded, constituting the cornerstone of treatment. Off-loading is combined with wound care. Surgical curative procedures are performed when conservative means fail and include internal off-loading, i.e., correction of the foot deformity and wound closure procedures. Off-loading is also important for infected ulcers but controlling the infection is essential. The infection is controlled by antibiotics, pus drainage, debridement of necrotic tissues including surgical debridement, and partial foot amputations. Diabetic ulcer is an expression of a complex systemic disease and requires treatment by multidisciplinary means, combining medical and paramedical personnel. The orthopedic surgeon plays a major role since a prominent part of the treatment involves foot surgery.