8
Treatment
Figure 2. Algorithm for Prevention and Care of Diabetic Foot
Offloading
DFU Prevention
• Patient education
• Annual foot exam
• Glycemic control (A1c <7%)
• Therapeutic footwear
• Semmes-Weinstein test
• ABI at age 50
Vascular risk factor
management
Patient
developed ulcer
Assess for
ischemia, infection
and neuropathy
ABI + TcP0
2
PTB
+ plain XR
Comprehensive
wound care
• Debridement
and follow up
q1–4wk
• Moist wound
bed, control
exudate,
and avoid
maceration
Suspected soft
tissue abscess or
osteomyelitis
MRI (if not
possible: leukocyte
or antigranulocyte
scan + bone scan)
Clinically
significant PAD
Revascularization
(either surgical
bypass or
endovascular
therapy)
Plantar DFU
Total contact cast
or irremovable
fixed ankle walking
boot
Non-plantar
(relieves
pressure at the
site of the ulcer)
Osteomyelitis
• Bone
debridement,
biopsy and
culture
• Antibiotics
• HBO
Healed
No response in
4 wks
Adjunctive wound
therapy (HBO,
NPWT, cellular and
extracellular agents)
Alternative for
frequent dressing
changes
Removable cast
