Multidisciplinary management of the diabetic foot ulcer

Diabetic foot ulcers are likely to occur in up to 25% of people with diabetes mellitus at some time in their life (Boulton et al, 2005). Without adequate management, there is a high risk of infection, gangrene, amputation and death. Over 50% of major amputations in the UK happen to people with diabetes, and within three years of amputation, 50% of patients will die. Diabetic foot ulcers need specific management, and some of the principles of moist wound healing do not apply. Diabetic patients with foot ulcers benefit from accurate and prompt assessment, diagnosis, treatment, and long-term follow-up in order to conserve the foot (Jeffcoate et al, 2006). Their management cannot be undertaken by one health care professional working in isolation, but should involve a multidisciplinary team to ensure that these complex wounds are treated appropriately. In this first of two articles, wound healing in the diabetic foot and the principles of assessment of the diabetic foot ulcer are discussed.