New Guidelines for Treating Diabetic Foot Ulcers

The Society for Vascular Surgery, the American Podiatric Medical Association, and the Society for Vascular Medicine have published new evidence-based, clinical practice guidelines for treating patients with diabetic foot ulcers (DFUs).

DFUs are a top concern of patients with diabetes, but specific guidelines for treating them were lacking.

To make its recommendations, the committee that constructed the guidelines reviewed current literature and used the Grades of Recommendation Assessment, Development, and Evaluation system.

The guidelines include recommendations in 5 areas:

  1. Prevention of diabetic foot ulceration: Patients with diabetes who are at a high risk of developing DFUs should use custom therapeutic footwear.
  2. Off-loading DFUs: Those with plantar DFUs should be off-loaded with a total contact cast or irremovable fixed ankle walking boot.
  3. Diagnosis of diabetic foot osteomyelitis: When diagnosing diabetic foot osteomyelitis, administer a probe-to-bone test and plain films first and then administer a magnetic resonance imaging (MRI) scan if a soft tissue abscess or osteomyelitis is suspected.
  4. Wound care for DFUs: If ulcers don’t heal after at least 4 weeks of standard care, adjunctive wound therapy options are recommended.
  5. Peripheral arterial disease (PAD) and the DFU: Patients with both PAD and DFU should receive surgical bypass or endovascular therapy revascularization.

“Whereas these guidelines have addressed 5 key areas in the care of diabetic foot ulcers, they do not cover all the aspects of this complex condition,” researchers concluded. “Going forward as future evidence accumulates, we plan to update our recommendations accordingly.”

—Amanda Balbi

Reference:

Hingorani A, LaMuraglia GM, Henke P, et al. The management of diabetic foot: A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. J Vasc Surg. 2016;63(suppl):3S-21S. doi:http://dx.doi.org/10.1016/j.jvs.2015.10.003.