Diabetic Foot Ulcers

7.1 (A) Price PE. Education, psychology and ‘compliance’. Diabetes Metab Res Rev.
2008; 24. Suppl 1:S101-5.

7.1 (B) Lehane, McCarthy, Geraldine. Medication non-adherence–exploring the
conceptual mire. International Journal of Nursing Practice. 2009;

7.1 (C) Sibbald RG, Ayello E, Alavi A. Screening for the high risk diabetic foot.     Advances in Skin and Wound Care 2012; 465-476.

Question: 7.1 (A)- What are the components of a high risk diabetic foot.

(B) Construct an enabler to assist diabetic patients to manage the  consequences of being diagnosed with a high risk diabetic foot.

7.2 (A)  Rogers LC, Driver VR, Armstrong DG.  Assessment of the diabetic foot.
In Sibbald RG, Ayello EA, Elliott JA, editors, WoundPedia: Wound                   Care Updates 2015: A Textbook for Healthcare Professionals & the IIWCC.          5th ed. Vol 2. WoundPedia, 2015. In Press.
7.2 (B)  Botros M, Goettl K, Parsons L, Menzildzic S, Morin C, Smith T, Hoar A,
Nesbeth H, McGrath S. Best practice recommendations for the
prevention, diagnosis, and treatment of diabetic foot ulcers: Update 2010.
Wound Care Canada. 2010;8(4):6-40.
Question: 7.2- In assessing a person with a diabetic foot ulcer, which elements are critical to evaluate?  How would you approach this assessment?

7.3  Armstrong DG, Bevilacqua NJ, Wu SC. Offloading foot wounds in people with
diabetes. In Sibbald RG, Ayello EA, Elliott JA, editors, WoundPedia: Wound          Care Updates 2015: A Textbook for Healthcare Professionals & the IIWCC.         5th ed. Vol 2. WoundPedia, 2015. In Press.

(Note: see also Botros 7.2)

Question: 7.3- Construct a chart identifying the advantages and disadvantages of various plantar pressure redistribution devices. Comment on how various devices can be integrated in your practice settings.

7.4 Tesfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, Lauria G,
Malik RA, Spallone V, Vinik A, Bernardi L, Valensi P. Toronto Diabetic
Neuropathy Expert Group. Diabetic neuropathies: update on definitions,
diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;

Question: 7.4- Outline and discuss a practical plan for the management of a diabetic patient with neuropathy and related symptoms.

7.5 (A) Grayson ML, Gibbons GW, Balogh K, Levin E, Karchmer AW. Probing to bone
in infected pedal ulcers:  A clinical sign of underlying osteomyelitis in
diabetic patients. JAMA. 1995; 273(9): 721-723.

7.5 (B) Dinh MT, Abad CL, Safdar N. Diagnostic accuracy of the physical examination
and imaging tests for osteomyelitis underlying diabetic foot ulcers: Meta-
analysis. Clin Infect Dis. 2008; 47(4):519-27.

Question: 7.5- Appraise the various methods to determine osteomyelitis. Comment on:
o    the level of evidence
o    clinimetric (clinical measurement) properties
o    clinical utility
o    how to translate this knowledge to action in your clinical practice setting.


(A)    Jeffcoate WJ, Harding KG. Diabetic foot ulcers. The Lancet. 2003; 361:1545-

(B)    Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendel CS, Lipsky BA.
Risk factors for foot infections in persons with diabetes. Diabetes Care.
2006; 29(6):1288-93.

(C)    Lipsky BA, Berendt AR, Deery G, Embil JM, Joseph WS, Karchmer AW,
LeFrock JL, Lew DP, Mader JT, Norden C, Tan JS.  Diagnosis and
treatment of diabetic foot infection. CID. 2004; 39:885-910.

(D)    Sherman RA. Maggot therapy for foot and leg wounds.  Lower Extremity
Wounds. 2002;1(2): 135-142.

(E)    Sibbald RG, Armstrong DG, Orsted HL. Pain in diabetic foot ulcers. Ostomy
Wound Management Suppl. 2003; 49(4Asuppl):24-29.

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