A simple guide to the prevention and treatment of Diabetic Foot Ulcers

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1 References: 1. Diabetes, foot care and foot ulcers. Available from http;//www.patient.co.uk. Diabetes foot ulcers. Available from patientinstructions htm 3. Parmet S, Glass TF, Glass RM. Diabetic foot ulcers. JAMA 005;93():60 doi: / jama Rowe VL. Diabetic ulcers. Accessed 5/1/01 5. Wu SC, Driver VR, Wrobel JS, et al. Foot ulcers in the diabetic patient, prevention and treatment. Vasc Health & Risk Management 007;3(1): Armstrong DG, Lavery LA. Diabetic foot ulcers: Prevention, diagnosis and classification. Am Fam Physician 1998;57(6): Mousley M. Understanding diabetic foot ulcers : Diagnosis and care. Nursing Times.net 007;103(3):8. 1. Allevyn product profile. INTRASITE Conformable and INTRASITE Gel Applipak S0 Reg. No.: 30/14./0117. Hydrogel dressing contains 0.03g modified Sodium Carboxymethyl Cellulose per gram of gel. 1. Intrasite Product Profile. Data on File. IRUXOL Mono Ointment S1 Reg. No.: G1633 (Act 101/1965). Contains per gram Collagenase Clostridiopeptidase A 1.0 units, Protease 0.4 units. 1. Iruxol Product Profile. IODOSORB Paste S0 Reg. No.: 37/14.1/047. Contains per gram of paste: 0.6g of Cadexomer Iodine equivalent to 0.591g of Cadexomer and 0.009g of Iodine. 1. Smith & Nephew. The practical guide to advanced wound management. 010/011 Edition. Data on file. It s TIME * to reduce the human and economic costs of chronic wounds *Adapted from International Advisory Board on Wound Bed Preparation Smith & Nephew (Pty) Ltd., 30 The Boulevard, Westend Office Park, Westville, T F VAR01 Trademark of Smith & Nephew Smith & Nephew 01 A simple guide to the prevention and treatment of Diabetic Foot Ulcers

2 CONTENTS 1. WHAT ARE DIABETIC FOOT ULCERS?. FACTS ABOUT DIABETIC FOOT ULCERS 3. PREVENTING DIABETIC FOOT ULCERS 4. PRODUCTS IN THE PHARMACY Visit for more information 1

3 1. WHAT ARE DIABETIC FOOT ULCERS?. FACTS ABOUT DIABETIC FOOT ULCERS A skin ulcer is an area of skin that has broken down and you can see the underlying tissue. Most skin ulcers occur on the lower legs or feet. 1 People with diabetes have a higher risk of developing foot sores or ulcers. 1, Diabetic foot ulcers are often painless because prolonged high blood sugar levels are linked with damage to the nerves in the feet. 3 This means that you cannot feel pain and you may not notice that you have injured your foot. 1 A diabetic foot ulcer can develop even after a minor injury such as stepping on a small stone with bare feet. 1 The ulcer is prone to infection and can take weeks or even months to heal. 1, Foot ulcers are the most common reason for hospital stays in people with diabetes. 15% of people with diabetes may develop a foot ulcer. 4 More than half of all diabetic foot ulcers become infected. 5 One in five patients with an infected diabetic foot ulcer may require some form of lower extremity amputation. 5 Foot ulcers can be serious. 1 Therefore, preventing foot ulcers and ensuring early and prompt treatment is most important

4 3. PREVENTING DIABETIC FOOT ULCERS Diabetic foot ulcers may be prevented by careful control of diabetes. 3,5 It is important to control blood sugar levels in order to prevent nerve damage to the feet or to stop it from worsening. 3,5 People with diabetes should check their feet, including the areas between the toes, for cuts and sores every day. 3 The feet, including the areas between the toes, should be kept clean and dry. 3 Wash the feet gently with soap and water, followed by the application of topical moisturisers. This helps to maintain skin that can better resist breakdown and injury. 6 The feet should not be soaked. Trim toenails carefully with the contour of the toe. Sharp nail edges should be filed smooth. If there is existing nerve damage to the feet, it is best to have a podiatrist evaluate the feet regularly. 3 Wear good fitting shoes that provide adequate support and avoid walking barefoot. 3 Have the feet examined at least once a year by a doctor or other health professional. 1 If you notice a new cut, bruise, blister or bleeding, speak to your doctor or podiatrist immediately. 1 If an ulcer develops, it is important for the patient to receive urgent treatment from the doctor and a wound care specialist or nurse who can examine, clean and redress the ulcer regularly

5 7 A TEAM APPROACH Patients with diabetes should receive care from an interdisciplinary team, in order to ensure the patient and the family receive adequate care PRODUCTS IN THE PHARMACY There is a wide range of products available for the treatment of diabetic foot ulcers. Products used to treat diabetic foot ulcers should be chosen based on their ability to: 7 Protect against contamination of the wound by bacteria and other germs. Reduce pressure on the ulcer. Handle wound fluid PATIENT Vascular Surgeon Plastic Surgeon Podiatrist Family Clinic Nurse Orthotist Family Doctor Physiotherapist Wound Care Diabetes Specialist Pharmacist Educator Diabetologist Dietitian Occupational Orthopaedic Therapist Prosthetist Surgeon Dermatologist If an ulcer develops, it is important for the patient to receive urgent treatment from the doctor and a wound care specialist or nurse who can examine, clean and redress the ulcer regularly. 1 ALLEVYN is a unique hydrocellular foam dressing, especially designed to keep the level of moisture at the wound bed optimal for wound healing. All ALLEVYN dressings are highly absorbent and can stay in place for up to seven days, which means fewer dressing changes are needed. All ALLEVYN dressings have a bacteria-proof top layer to minimise risk of contamination. All ALLEVYN dressings are soft and cushioning, giving excellent comfort and protection. All ALLEVYN dressings have a low adherent wound contact layer to minimise the risk of further trauma upon removal. ADHESIVE Suitable for normal skin The dressing is waterproof which allows for showering and light cleaning The dressing should not be cut Absorbs moderate to high levels of wound fluid ALLEVYN NON-ADHESIVE Suitable for fragile skin Non-adhesive Painless to remove Can be cut to suit various wound shapes and locations Absorbs moderate to high levels of wound fluid VALUE PACK VALUE PACK Sterile Dressings Fragile skin Non-adhesive Soft & cushioning Painless to remove Sterile Dressings 100 mm x 100 mm Normal skin Bacteria & water proof Highly absorbent Soft & cushioning 15 mm x 15 mm MOIST WOUNDS PRESSURE ULCERS DIABETIC FOOT ULCERS *smith&nephew ADHESIVE The Wound Care Professional s Choice MOIST WOUNDS PRESSURE ULCERS DIABETIC FOOT ULCERS The Wound Care Professional s Choice *smith&nephew NON-ADHESIVE Hydrocellular Foam Dressing Hydrocellular Foam Dressing 8

6 9 ALLEVYN GENTLE Gentle dressing with silicone wound contact layer for fragile skin The dressing is waterproof which allows for showering and light cleaning For moderately oozing wounds Easy to dress awkward areas such as fingers, toes, knees and heels The dressing should not be cut INTRASITE Unique Hydrogel Wound Dressing, a Gentle Debriding Agent Gently cleans the wound to remove dead tissue 1 Adds moisture to the wound 1 Promotes wound healing 1 INTRASITE Conformable for gentle packing of cavity wound to allow healing from base 1 Contra-Indications: INTRASITE Conformable VALUE PACK Gentle dressing for fragile skin Bacteria & water proof Soft & cushioning Moderately oozing wounds Sterile Dressings 55 mm x 10 mm MOIST WOUNDS PRESSURE ULCERS DIABETIC FOOT ULCERS *smith&nephew GENTLE Silicone Gel Adhesive Hydrocellular Dressing The Wound Care Professional s Choice INTRASITE Gel Applipak INTRASITE Gel Applipak is for external use only and should not be taken by mouth. Hypersensitivity to any of the ingredients. Do not use on exposed muscle, tendon or bone. Do not use on deep partial thickness and full thickness burns. IRUXOL Mono Unique Collagenase Ointment, Natural, Gentle and Effective Natural Like human tissue enzymes it helps the body s own healing processes 1 Gentle Works on dead tissue, not harming healthy tissue 1 Effective Allows healing to continue 1 Contra-Indications: Additional preparations for topical use should not be applied, since such preparations may influence the activity of IRUXOL Mono ointment. IODOSORB Unique Cadexomer Iodine, Dual Action Antimicrobial Dressing Effective for up to 7 hours 1 Helps manage excess fluids 1 Dressing should be changed Contra-Indications: Known or suspected hypersensitivity to iodine. Cadexomer iodine should not be used on patients with Hashimoto s Thyroiditis, Thyroid disease, patients with a prior history of Grave s disease and non-toxic nodular goitre. There is no experience in pregnant women and children, therefore IODOSORB use is not recommended. 10

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