Wound healing 101 is missing: what is driving poor practice in diabetic foot ulcer wound care?

Caroline Fife

There is an epidemic of diabetes-related lower extremity amputations (LEA) occurring in the US, and the global situation is likely similar. After declining 43% between 2000 and 2009, the age adjusted rate of LEAs in the U.S. increased by 62% between 2009 and 2015.¹

Many, if not most of these amputations, result from complications of plantar diabetic foot ulcers (DFUs), which are among the more challenging clinical scenarios faced by wound care providers. Most of these wounds become infected, and about 20% of DFUs will necessitate an amputation.² Further complicating this healthcare crisis is that the most financially vulnerable members of society, particularly in communities of color, disproportionately bear the brunt of the morbidity and mortality.³

Undoubtedly, multiple factors are contributing to the increase in amputations, but we cannot ignore the probability that gaps in the quality of wound care are contributing to this crisis. As a wound care practitioner, what is deeply frustrating is knowing that much of the morbidity and mortality associated with DFUs could be avoided with the use of simple, inexpensive and straightforward offloading therapy. Offloading of vulnerable areas of the plantar surface is about as basic as it gets when it comes to plantar DFU wound care. It has been demonstrated time and time again that most plantar diabetic foot ulcers can be successfully healed when patients adhere to using appropriate and effective offloading devices.^4,5,6