Abstract
Background and Purpose: Published guidelines for effective management of diabetic foot ulcers (DFU) include total contact casting (TCC). The purpose of this case study is to describe the application of best practice guidelines for the treatment of a diabetic foot ulcer (DFU) in a complex patient where TCC offloading could not be utilized. Case Description: The patient was a 47 year-old female with a five-plus year history of a full-thickness DFU on the left plantar mid-foot. Treatment included sharp and ultrasound debridement, the use of a silver hydrofiber dressing, edema management via compression therapy, negative pressure wound therapy, offloading via customized 1/4 inch adhesive-backed felt applied to the plantar foot in addition to an offloading boot and use of a wheelchair, patient education regarding diabetes management, and the application of a bilayered living skin-equivalent biologic dressing. Outcomes: At 15 weeks the wound was closed and the patient was transitioned into diabetic footwear. Discussion: The felt offloading was a beneficial alternative to TCC. The patient’s longer than average healing rate may have been complicated by the duration of her wound, her 41 year history of diabetes, and the fact that gold standard offloading (TCC) was not able to be used. Further research is needed regarding the use of felt for offloading, such as application technique for wounds on different areas of the foot, comparison of different types of felt, and the use of felt in conjunction with various offloading devices.
Highlights
The Centers for Disease Control and Prevention (CDC) reports the incidence of diabetes nationally to be 9.3%, or 29.1 million people
These together can lead to repetitive micro trauma and the development of diabetic foot ulcers (DFUs)
Peripheral artery disease is prevalent in those with diabetes and has been reported to be a significant contributing factor in the development of DFUs in up to 50%
Summary
The Centers for Disease Control and Prevention (CDC) reports the incidence of diabetes nationally to be 9.3%, or 29.1 million people. Risk factors for DFU include previous amputation, past foot ulcer history, peripheral neuropathy, foot deformity, peripheral vascular disease, visual impairment, diabetic nephropathy, poor glycemic control, and cigarette smoking [4]. Best Practice Guidelines: Wound Management in Diabetic Foot Ulcers [14] states that the most effective care of DFUs involves a holistic approach and must include optimal diabetes control, effective local wound care, infection control, pressure relieving strategies, and optimization of blood flow. International Working Group on the Diabetic Foot (IWGDF) guidelines [18] recommend pressure relief and protection of the ulcer, restoration of skin perfusion, management of infection, metabolic control, treatment of co-morbidities such as edema and malnutrition, local wound care including frequent inspection, sharp debridement, and dressings that manage exudates and maintain a moist wound environment, and education for patients and caregivers about appropriate self-care. The purpose of this case study is to describe the application of best practice guidelines for the treatment of DFUs in a complex patient where TCC offloading could not be utilized
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