Wound Bed Preparation for Chronic Diabetic Foot Ulcers

Table 1

Local factors and the management.

Local factors	Effect	Aim	Management
Peripheral neuropathy	(1) Loss of pain sensation—prone to trauma	(1) Prevent progression of peripheral neuropathy	(1) Glucose control
	(2) Loss of intrinsic foot balance leading to hyperflexion of MTPJ and hyperflexion of IPJ—uneven pressure distribution	(2) Foot hygiene and prevention of trauma	(2) Appropriate footwear and podiatric advice
	(3) Charcot joint	(3) Prevention of callus formation	(3) Moisturizing
	(4) Autonomic neuropathy—lack of sweating, dry skin, and fissuring	(4) Keeping skin soft and moist	(4) Dietary supplement
Peripheral vascular disease; (ABI or TBI < 0.8)	Poor foot perfusion	Restoration/optimization of tissue perfusion	Referral to vascular surgeon—angiogram, angioplasty, stenting, or bypass if possible
Inappropriate footwear—with heel, narrowed/cramped toes area	(1) Uneven pressure distribution—callosity, pressure ulceration; (2) Trauma	Eliminate risk/pressure	Wear soft, fully covered shoes or sandals with back strapping, flat sole; The presence of an ulcer or wound may require a special prescription shoe; Treatment/removal of callus—alleviate pressure, aids advancing epithelium