From the Guidelines
Calcium alginate with silver should not be used for wound healing of diabetes-related foot ulcers, including those on the heel, due to the lack of sufficient evidence supporting its effectiveness. According to the International Working Group on the Diabetic Foot (IWGDF) 2023 update, published in Diabetes/Metabolism Research and Reviews in 2024 1, the current evidence does not support the use of collagen or alginate dressings, including those with silver, for enhancing wound healing in diabetic foot ulcers.
The IWGDF guidelines recommend against using collagen or alginate dressings for wound healing of diabetes-related foot ulcers, citing 12 RCTs that showed no significant difference in wound healing or reduction in ulcer area at the end of the study duration 1. While calcium alginate dressings with silver may provide a moist healing environment and antimicrobial properties, the evidence suggests that these benefits do not translate to improved wound healing outcomes for diabetic patients.
Key considerations for managing diabetic heel wounds include:
- Maintaining a moist healing environment
- Controlling infection
- Minimizing trauma during dressing changes
- Accommodating moderate to heavy drainage However, these considerations should be addressed through evidence-based treatments that have demonstrated effectiveness in promoting wound healing and preventing complications in diabetic patients.
Regular wound assessment by healthcare professionals remains essential for diabetic patients to monitor healing progress and adjust treatment as needed. Healthcare providers should follow the IWGDF guidelines and recommend treatments that are supported by strong evidence, rather than relying on dressings with limited or conditional recommendations 1.
From the Research
Wound Care for Diabetics
- Diabetic foot ulcers (DFUs) are a significant complication of diabetes, requiring multidisciplinary management and patient education 2
- Treatment modalities for DFUs include debridement, off-loading, negative pressure therapy, dressings, and topical therapies, with varying levels of evidence to support their use 2, 3
Calcium Alginate with Silver
- A study comparing Hydrofiber dressing containing ionic silver with calcium alginate dressings in non-ischaemic diabetic foot ulcers found that both dressings improved healing outcomes, with the silver dressing reducing ulcer depth more effectively 4
- The use of silver foam dressing in combination with surgical debridement, maggot therapy, and negative pressure wound therapy has been reported to revive hope for patients with diabetic foot ulcers, including those with infected ulcers 3
Wound-Healing Protocols
- A paradigm for wound healing in diabetic foot and pressure ulcers includes recognition of risk factors, daily self-examination, initiation of treatment protocols, objective measurement of wound progress, and establishment of a moist wound-healing environment 5
- Debridement is a standard of care for DFU wounds, with various techniques available, including surgical, autolytic, and enzymatic debridement 6
Application to Diabetic Heel Wounds
- Calcium alginate with silver may be a useful dressing for diabetic heel wounds, given its potential to reduce ulcer depth and promote healing 4
- A comprehensive approach to wound care, including debridement, off-loading, and local wound care, is critical for promoting healing in diabetic foot ulcers, including those on the heel 2, 3, 6