Updating the Diabetic Foot Treatment Algorithm: Recommendations on Treatment Using Advanced Medicine and Therapies

Since the last diabetic foot ulcer (DFU) treatment algorithm was published in 2002, new options for diagnostic testing and treatments have been developed. This study seeks to update the DFU treatment algorithm to include new options available in diagnostic testing and treatment.

A computerized literature search of peer-reviewed articles published between January 2003 and January 2016 was conducted using MEDLINE (PubMed), EMBASE, and the Cochrane Library. Diabetic foot ulcer treatment algorithms were reviewed and changes recommended based on current standards of care, new treatment modalities, and clinical experience.

A multidisciplinary approach is recommended to address potential underlying problems. A visual inspection, foot pulse palpation, skin temperature measurement, and shoe gear, gait, orthopedic, neurologic, and vascular exams are recommended. Appropriate offloading and continuing diabetes education are included as treatment for all DFUs. If calluses or increased foot pressure are present, preventative care is necessary to prevent further tissue breakdown. If infection is present, treatment should follow the Infectious Diseases Society of America diabetic foot infection guidelines. As the DFU severity increases, advanced wound dressings and advanced wound therapies should be employed. In acute/chronic and acute/urgent DFUs, debridement, amputation, and skin grafting may be required.

Treatment for DFUs should start when a possible pre-ulcer is noticed. This prophylactic treatment may reduce development of more severe DFUs. Once a DFU has developed, care should be optimized for both the patient and the wound bed. While these treatment recommendations are focused solely on DFUs, they may be expanded for use in other foot/leg pressure ulcers.