Management of Diabetic Foot Ulcers: Best Practices for Care Professionals

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
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Introduction:
Diabetic foot ulcer can be defined as a complication that results due to Diabetes
mellitus. The condition is also referred to as diabetic foot. The normal physiological process
of wound healing comprises of a stepwise process of repairing the extracellular matrix which
forms the largest part of the dermal skin. However, it should be critically noted that the
normal wound healing procedure is disrupted in certain cases of metabolic and physiological
orders. One such condition includes the case of the metabolic disorder Diabetes mellitus that
delays the normal process of wound healing. Studies have indicated that the condition of
Diabetes mellitus interferes with the process of wound healing and present a prolong period
of inflammation (Alavi et al. 2014). The long period of inflammation leads to a delay in the
formation and maturation of a granulation tissue that subsequently leads to a reduction in the
tensile strength of the wound. Typically, the characteristics of a diabetic foot ulcer varies
across different demographics (Martins et al. 2014). In general the treatment intervention
used for treating diabetic foot ulcers include monitoring and controlling the blood glucose
level, removal of dead tissues from the wound, administering effective wound dressings and
eliminating pressure from the wounds with the help of techniques that include, total contact
casting and in extreme cases surgery or amputation. Hyperbaric oxygen therapy is also
administered in certain cases, however it is not used commonly on account of greater cost.
Diabetic foot ulcer is extremely common and it affects 15% of the patients who are diagnosed
with Diabetes mellitus (Martins et al. 2014). It should be further noted that diabetic foot ulcer
precedes 84% of the fatal conditions that results in leg amputation.
Discussion:
Prior to discussing about the best practice for the management of foot ulcer, it is
important to note that diabetic foot ulcers are categorized into several levels. These levels are

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referred to as Grades. Grade 0 represents no ulcers in a high risk foot. Grade 1 represents
superficial ulcers that involves complete skin thickness but does not include the underlying
tissues (Iraj et al. 2013). Grade 2 includes deep ulcers that penetrate to the muscles and
ligaments, however it does not involve the bones in the process of an abscess formation (Iraj
et al. 2013). Grade 3 includes, deep ulcers characterised by cellulitis and abscess formation
which leads to a condition known as osteomyelitis (Iraj et al. 2013). Grade 4 includes
localized gangrene and Grade 5 comprises of the extensive gangrene that covers the entire
foot (Iraj et al. 2013). It should be mentioned in this regard that a number of risk factors that
lead to the development of diabetic foot ulcers include old age, infection, diabetic
neuropathy, peripheral vascular disease, poor glycaemic regulation, cigarette smoking,
ischemia of blood vessels and previous history of foot amputation or ulcers (Rice et al. 2014).
In addition to this, previous medical history of foot disease, renal failure, oedema and foot
deformities could also lead to diabetic foot ulcer. Patients suffering from Diabetes also suffer
from a condition of diabetic neuropathy that is caused due to impaired neurovascular and
metabolic factors. In this regard, it should be noted that peripheral neuropathy leads to
numbness within the toes, feet, legs or arms due to the damage caused within the distal nerves
and interrupted blood flow (Armstrong et al. 2017). Further, blisters and sores manifest on
the numbed regions of the feet and legs which includes the matatarso-phalangeal joint region
and the heel region (Armstrong et al. 2017). On account of the numbness the injuries remain
unnoticed and invariably become sites of bacterial infections (Rice et al. 2014).
Nurses and allied health care professionals have been invariably involved in the
management of foot ulcers in Diabetic patients. Nurses are primarily concerned with the
process of imparting self-management training and education about foot ulcers. As mentioned
by Morua et al. (2013), nurses ideally identify the changes in the pattern of foot and skin
sensation which helps in the early detection of foot ulcers (Moura et al. 2013). Further, caring