Treating a foot ulcer in a diabetic needs a multispecialty approach emphasize Dr Bhartal a certified foot and ankle surgeon.

Team@CMHF

Diabetic foot ulcers, also referred to as mal perforans or neurotrophic ulcerations, are the leading cause of hospitalization in patients with diabetes.

Lower extremity ulceration is also the leading cause of partial foot and leg amputations. Treatment of the neurotrophic ulcer is often problem focused and does not address the complex underlying etiologies. Incorporating a multidisciplinary approach is essential to achieve rapid closure of the wound, prevent recurrence, and ultimately reduce the incidence amputation.

The underlying etiology of the diabetic foot ulcer includes peripheral neuropathy, increased plantar pressures, and peripheral arterial disease. Complicating factors often include inadequate glycemic control, infection, and poor nutritional status.

Successful treatment requires a comprehensive medical evaluation to assess and manage the multiple co-morbidities that frequently present with these patients.

Surgical debridement, mechanical off-loading, and infection management are principle modalities for treating the neurotrophic ulcer. Extrinsic off-loading, which includes pressure relief shoes, total contact casting, and non weight-bearing status are often successful. Recalcitrant cases may require surgical intervention. Achilles tendon lengthening and resection/correction of osseous deformities have been used successfully to decrease plantar pressures.

Vascular intervention in the diabetic patient with peripheral arterial disease is often indicated. Noninvasive vascular studies, such as Pulse Volume Recordings, ABI, and segmental pressures, are used to assess the degree of PAD. Recent advances in the field of endovascular surgery may offer a less invasive alternative to traditional revascularization procedures.

Aa comprehensive, multidisciplinary approach for treatment of the neurotrophic ulcer is critical to achieve long-term success and thereby reduce the incidence of lower extremity amputations.

Ref; http://www.mdnews.com/news/2012_02/05737_janfeb2012_the-diabetic-foot