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Treatment
Off-Loading DFUs
➤ In patients with plantar DFU, we recommend off-loading with a total
contact cast (TCC) or irremovable fixed ankle walking boot (1B).
➤ In patients with DFU requiring frequent dressing changes, we suggest
off-loading using a removable cast walker as an alternative to TCC and
irremovable fixed ankle walking boot (2C).
• We suggest against using postoperative shoes or standard or customary footwear
for off-loading plantar DFUs (2C).
➤ In patients with nonplantar wounds, we recommend using any
modality that relieves pressure at the site of the ulcer, such as a
surgical sandal or heel relief shoe (1C).
➤ In high-risk patients with healed DFU (including those with a
prior history of DFU, partial foot amputation, or Charcot foot), we
recommend wearing specific therapeutic footwear with pressure-
relieving insoles to aid in prevention of new or recurrent foot ulcers
(1C).
Wound Care For DFUs
➤ We recommend frequent evaluation at 1- to 4-week intervals with
measurements of diabetic foot wounds to monitor reduction of wound
size and healing progress (1C).
➤ We recommend evaluation for infection on initial presentation of all
diabetic foot wounds, with initial sharp débridement of all infected
diabetic ulcers, and urgent surgical intervention for foot infections
involving abscess, gas, or necrotizing fasciitis (1B).
➤ We suggest that treatment of DFIs should follow the most current
guidelines published by the Infectious Diseases Society of America
(IDSA) (U).
➤ We recommend use of dressing products that maintain a moist wound
bed, control exudate, and avoid maceration of surrounding intact skin
for diabetic foot wounds (1B).
➤ We recommend sharp débridement of all devitalized tissue and
surrounding callus material from diabetic foot ulcerations at 1- to
4-week intervals (1B).
➤ Considering lack of evidence for superiority of any given débridement
technique, we suggest initial sharp débridement with subsequent
choice of débridement method based on clinical context, availability
of expertise and supplies, patient tolerance and preference, and cost-
effectiveness (2C).
