From the Guidelines
For a beefy red diabetic heel ulcer, the most effective treatment approach is to focus on wound cleansing, debridement, infection control, and offloading pressure, with sharp debridement being the preferred method for removing nonviable tissue, as recommended by the most recent guidelines 1. The treatment plan should include daily wound cleansing with normal saline or a gentle wound cleanser, followed by the application of an appropriate dressing based on wound characteristics. Key considerations for dressing selection include:
- Exudate control
- Comfort
- Cost As suggested by the guidelines, dressings should be chosen based on these factors, rather than containing surface antimicrobial agents or other additives 1. Offloading pressure is crucial to prevent further injury and promote healing, and can be achieved through the use of specialized diabetic footwear, total contact casting, or a removable cast walker. Blood glucose control is also essential for healing, with a target HbA1c below 7%. If infection is present, oral antibiotics like amoxicillin-clavulanate may be necessary, and regular follow-up with a wound care specialist is important to prevent complications like osteomyelitis or amputation. It is also important to note that some treatments, such as autolytic, biosurgical, hydrosurgical, chemical, or laser debridement, are not recommended over standard of care, including sharp debridement 1.
Some key points to consider when treating a beefy red diabetic heel ulcer include:
- Monitoring for signs of infection, such as increased redness, warmth, swelling, or purulent discharge
- Using sharp debridement to remove nonviable tissue, as recommended by the guidelines 1
- Selecting dressings based on exudate control, comfort, and cost, rather than containing surface antimicrobial agents or other additives 1
- Offloading pressure to prevent further injury and promote healing
- Maintaining blood glucose control to support healing, with a target HbA1c below 7%
From the Research
Treatment for Diabetic Foot Ulcers
The treatment for a beefy red, left heel diabetic ulcer typically involves a multidisciplinary approach, including:
- Debridement: the removal of dead tissue and bacteria from the wound 2
- Offloading: reducing pressure on the affected area to promote healing 2, 3, 4, 5
- Infection control: managing and preventing infection to promote a healthy environment for healing 2
- Adequate perfusion: ensuring good blood flow to the affected area to promote healing 2
Offloading Methods
Various offloading methods can be used to reduce pressure on the affected area, including:
- Total contact cast (TCC): a well-established treatment option for diabetic foot ulcers 6, 4, 5
- Removable cast walker (RCW): a device that can be used to offload pressure from the affected area 4
- Graded-stiffness footwear device: a novel device that uses multi-increasing levels of stiffness materials to offload pressure from the heel 3
- Non-removable casts: have been shown to be more effective in healing diabetes-related plantar foot ulcers than removable casts or dressings alone 5
Adjunctive Therapies
Adjunctive therapies, such as negative pressure wound therapy, skin substitutes, and platelet-derived growth factor, may also be used to promote healing, although the evidence for these therapies is limited 2