Foot affected by ulceration that is associated with neuropathy and/or peripheral arterial disease of the lower limb in a patient with diabetes.(DFU)

Global Impact

Diabetic foot is one of the most significant and devastating complications of diabetes. [Read more: Diabetic Foot]

Nearly 15% of diabetics develop a foot ulcer, of which20% will require amputation.

Nearly 50% will require a re-amputation within a year or so.

Every 20 seconds diabetes is costing a limb to man.

The risk of foot ulceration and limb amputation increases with age and the duration of diabetes

Who is Going To Treat My DFU?

It is best managed by a team of Diabetologist , General Surgeon, Vascular surgeon, Plastic surgeon, Wound care nurses.

Evaluation Of Diabetic Foot Ulcer

Detailed evaluation facilitates the correct choice of treatment and reliable monitoring of the healing progress of the ulcer.

  1. Examination Of Ulcer
  2. Vascular Evaluation.
  • Ankle-brachial Index(ABI)
  • Peripheral Pulses
  1. Neurological Evaluation
  • Neuropathy Symptom Score (NSS) and
  • Neuropathy Disability Score (NDS)
  • Physical Examination of Foot is done to assess the

Perception of superficial pain (pinprick),

Temperature sensation (using a two-metal rod),

Light sensation (using the edge of a cotton-wool)

Pressure (using the Semmes–Weinstein 5.07 monofilament

Vibration perception (tuning fork)

Position sense (proprioception)

Deep tendon reflexes (Achilles tendon, patellar)

AIM Of Treatment

  • Early wound healing.
  • Prevent amputation.
  • Patient Education.
  • Good Glycaemia Control.

Basic Tenets Of Treatment

  1. Debridement/Dressing
  2. Infection control.
  3. Off-Loading
  4. Moist Wound Healing
  5. Rehabilitation.


  • Gold standard of treatment
  • Removes surface debris, slough, necrotic tissue, by cutting them.
  • Promotes formation of granulation tissue.
  • Decreases peri-wound pressure
  • Decreases wound infection.


Regular Dressings follow after debridement to

  • Prevent tissue dessication.
  • Absorb excess fluid.
  • Prevent contamination of wound.
  • Provide moist conditions for healing.

Read more: Diabetic Foot


Antibiotics are selected according to the organism causing infection.

Patients are usually hospitalised to administer them intravenously.


Extremely important for the healing of plantar ulcers.

Inadequate off-loading can lead to delay in ulcer healing and increased recurrence.

The most effective method of off-loading

  • TCC (Total Contact Cast – removable)
  • Half shoes
  • Wheelchair
  • Crutches

Advances in Treatment Of Diabetic Foot Ulcer.

For the chronic and non-healing diabetic foot ulcers

  1. Bioengineered Skin and Tissue
  • Human Fibroblast Derived Dermal Substitute
  • Allogenic Bilayered Cultured Skin Equivalent.
  1. Negative Pressure Wound Therapy
  2. Hyperbaric Oxygen Therapy.
  3. Electrical stimulation.
  4. Growth Factors
  • PDGF

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