1. Foot Ulcers: Objectives • Discuss the work-up and treatment of common foot ulcers

2. Clinical Scenario • A 56 year old man with history of uncontrolled diabetes, diabetic neuropathy, lower extremity peripheral artery disease, venous insufficiency, and recent immobility following a stroke presents with a foot ulcer • How do you work-up and treat this foot ulcer?

3. Work-up • Determine extent of the ulcer: If osteo suspected, get imaging (e.g. MRI) and if applicable, bone biopsy for culture • Note: Fever/chills/leukocytosis may not always be present with soft tissue infxn or osteomyelitis

4. Treatment • Moist or dry dressings on clean, granulating tissue with/out topical antibiotics • No skin cleansers or antiseptics (Hydrogen peroxide or Betadine) as it destroys granulating tissue • Skin grafting (Plastics) may be needed for large ulcers • Wound debridement and systemic antibiotics may be necessary if associated cellulitis or osteomyelitis

5. Treatment • Identify and treat the underlying cause of the foot ulcer • Common underlying causes of foot ulcers: Arterial insufficiency, neuropathy (e.g. diabetic), venous stasis, pressure

6. Treatment

7. Summary • When evaluating a foot ulcer: determine the extent of disease, treat the ulcer, and treat the underlying cause of the ulcer to promote healing and prevent re-occurence

8. Resources • Sumpio BE. Foot Ulcers. N Engl J Med. Sept 14 2000;343(11):787-793 • Angie N, Bergan J. Chronic Venous Ulcer. BMJ. April 5 1997;314(7086):1019-1023 • Bluestein D, Javaheri A. Pressure Ulcers: Prevention, Evaluation, and Management. Am Fam Physician. Nov 14 2008;78(10):1186-1194