Critical Reviews™ in Physical and Rehabilitation Medicine

ISSN for PRINT: 0896-2960

For Online Access

2000, Volume12

Issue 1

96 pages

Issue price - $163.00

C. Keith Bowering
University of Alberta, Edmonton, Alberta, Medical Director, Diabetes Foot Clinic, Royal Alexandra Hospital, Edmonton, Alberta

Foot ulceration in patients with diabetes is a common complication that previously has often led to lower-limb amputation. The primary underlying factors involved with ulceration in this population are peripheral neuropathy and ischemia. Through the aggressive, innovative approaches of a multidisciplinary foot ulcer team, most neuropathic foot ulcers now heal. For those with primarily ischemic ulcers, surgical revascularization as far distal as the dorsalis pedis artery has significantly improved the salvage rate of diabetic limbs in patients who otherwise would have proceeded to limb loss. Essential components of foot ulcer care incorporate debridement of the ulcer to a clean base, addressing the possibility of wound infection and osteomyelitis, maintenance of an optimal, moist wound-healing environment, and avoidance of further trauma by ensuring adequate off-loading of the ulcerated foot. Newer therapies such as human recombinant platelet-derived growth factor and tissue-engineered skin replacements have added further tools to help close hard-to-heal neuropathic foot ulcers. The ultimate goal is primary prevention of diabetic foot complications. This is achievable in many circumstances by improved patient and physician education regarding diabetes and the principles of good foot care.

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