The diabetic foot: evolving technologies

Diabetic malperforans ulcers are extremely challenging problems, and their treatment requires a multidisciplinary approach. The wound management technique is based on the depth of ulceration; necrosis and infection should be aggressively managed. Wound healing and prevention of adjacent breakdown is best assured through casting and professional shoewear techniques. The vascular aspects of the patient's disease must be addressed. Patients failing this multidisciplinary team approach may be candidates for adjunctive management. If transcutaneous oxygen studies indicate diminished oxygen perfusion, hyperbaric oxygen might be considered. Contraindications to this modality are certain pulmonary problems, including chronic obstructive pulmonary disease and pulmonary fibrosis. Some individuals, particularly those with claustrophobia, may find small hyperbaric chambers psychologically unacceptable. Studies on tissue and platelet growth factors are encouraging. Limited clinical experience with these materials has been encouraging and future clinical applications are anticipated; however, like hyperbaric oxygen, these growth factors are only an adjunct to a comprehensive foot care program.