Patients with diabetic ulcers require a multidisciplinary approach with primary care coordination of a variety of specialists to promote healing and prevent limb loss.

For patients with prior diabetic foot or leg wounds, poor diabetic control, peripheral vascular disease, renal disease or other illnesses that compromise healing, we strongly recommend referral to a wound clinic for evaluation and management.

• This includes patients with ulcers that expose subcutaneous structures when probed to tendon or bone, if wound is >30 days old or debridement of necrotic tissues/callous is needed.
• For patients with poor or limited self-care who are homebound due to illness, referral to home care wound nurse specialist is highly recommended.

• Optimizing glucose control improves wound healing.
• High HgA1c (>8%) is associated with poor outcomes.

• Clinically significant vascular disease should be assessed by checking for palpable pulses.
• Due to frequent calcification of arteries in diabetics, basic vascular studies with toe-brachial indexes (TBI) are more reliable indicators of adequate perfusion.
• TBI should be >7.0.

• Initial course of antibiotics is 1-2 weeks for mild infections and >3-6 weeks for moderate to severe infections.
• May need Infectious Disease consult.
• If wound is severely infected and patient is acutely ill, recommend hospitalization for IV antibiotics.

Wound bed preparation with debridement of necrotic, non-viable tissues is necessary to reduce infection, stimulate new tissue growth, and promote healing.