The document discusses current treatments and advanced therapies for diabetic foot complications, outlining risk factors like neuropathy and vascular issues that can lead to foot ulcers, and describing approaches to managing dermatological issues, nerve damage, musculoskeletal problems, vascular challenges, and proper shoegear through treatments like VAC therapy, debridement, dermal substitutes, revascularization, and diabetic footwear modifications.

1. Diabetic Foot Complications –
Current treatments and
advanced therapies in treating the diabetic
foot
Don Pelto, DPM
Central Massachusetts Podiatry, PC
Worcester, MA

2. Objectives
• Participants will understand incidence and
economic impact of diabetic foot infections
• Participants will define the risk factors leading
to diabetic foot infections
• Participants will learn to diagnose an “at risk”
diabetic foot
• Participants will understand current
treatments and advanced therapies in the
standard of care/treatment for diabetic foot
ulcers

3. Case Study M.S.
• CC: Chronic ulceration
right foot
• PMH: DM-2, HTN,
Restless Leg Syndrome
• PSH: Unremarkable
• NKDA
• Meds: Glucophage,
Humalog, Miripex,
Lisinopril

4. Diabetic Foot Ulcers
• One of the most common complications of diabetes
• Annual incidence 1% to 4%1-2
• Lifetime risk 15% to 25%3-4
• ~15% of diabetic foot ulcers result in lower extremity
amputation3,5
• ~85% of lower limb amputations in patients with
diabetes are preceded by ulceration6-7
• Peripheral neuropathy is a major contributing factor in
diabetic foot ulcers1-7
1. Reiber and Ledoux. In The Evidence Base for Diabetes Care. 4. Boulton et al. Lancet. 2005;366:1719.
Williams et al, eds. Hoboken, NJ: John Wiley & Sons; 5. Ramsey et al. Diabetes Care 1999;22:382.
2002:641–665. 6. Pecoraro et al. Diabetes Care. 1990;13:513.
2. Boulton et al. NEJM. 2004;351:48. 7. Apelqvist and Larsson. Diabetes Metab Res Rev.
3. Sanders. J Am Podiatry Med Assoc. 1994;84:322. 2000:16:S75.

5. Costs to Treat a Diabetic Foot Ulcer
Over a 2-Year Period Following Detection
Ramsey et al. Diabetes Care. 1999;22:382.
Cost analyses based on percent change in the medical component of the US consumer price index.

6. 5-Year Mortality Rates
Armstrong DG, Wrobel J, Robbins JM. Guest Editorial: are diabetes-related wounds
and amputations worse than cancer? Int Wound J. 2007;4(4):286–287

7. The Diabetic Foot – Risk Factors
The Comprehensive
Diabetic Foot Exam
• Dermatological Considerations
• Nerve Considerations
• Osseous Considerations
• Vascular Considerations
• Shoegear Considerations
Pinzur et al. Foot & Ankle International. 2005;26:1:113-119. Guidelines for diabetic footcare.
Valk GD, Kriegsman DMW, Assendelft WJJ. Patient education for preventing diabetic foot ulceration.
Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD001488. DOI:
10.1002/14651858.CD001488.pub2.

8. Current and Advanced Treatments for
Wounds

9. Dermatological Considerations
• Dry Skin
• Fungal Infection
• Callus
• Interdigital lesions
• Ingrown Nail
• Ulceration

10. Dermatological Considerations
• Dry Skin
• Fungal Infection
• Callus
• Interdigital lesions
• Ingrown Nail
• Ulceration

11. Dermatological Considerations
• Dry Skin
• Fungal Infection
• Callus
• Interdigital lesions
• Ingrown Nail
• Ulceration

12. Dermatological Considerations
• Dry Skin
• Fungal Infection
• Callus
• Interdigital lesions
• Ingrown Nail
• Ulceration

13. Dermatological Considerations
• Dry Skin
• Fungal Infection
• Callus
• Interdigital lesions
• Ingrown Nail
• Ulceration

14. Dermatological Considerations
• Dry Skin
• Fungal Infection
• Callus
• Interdigital lesions
• Ingrown Nail
• Ulceration

15. Dermatological Considerations
• Dry Skin
• Fungal Infection
• Callus
• Interdigital lesions
• Ingrown Nail
• Ulceration

16. Dermatological Considerations
• Dry Skin
• Fungal Infection
• Callus
• Interdigital lesions
• Ingrown Nail
• Ulceration

17. Dermatological Considerations
• Dry Skin
• Fungal Infection
• Callus
• Interdigital lesions
• Ingrown Nail
• Ulceration
Spencer SA. Pressure relieving interventions for preventing and treating diabetic foot ulcers.
Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD002302. DOI:
10.1002/14651858.CD002302.

18. Dermatological Treatments
• Callus
– Diabetic shoes
• Ulceration
– VAC
– Debridement
– Dermal Skin Substitute
– Platelet Rich Plasma
Spencer SA. Pressure relieving interventions for preventing and treating diabetic foot ulcers. Cochrane Database of Systematic
Reviews 2000, Issue 3. Art. No.: CD002302. DOI: 10.1002/14651858.CD002302.

19. Dermatological Treatments
• Callus
– Diabetic shoes
• Ulceration
– VAC
– Debridement
– Dermal Skin Substitute
– Platelet Rich Plasma
Ubbink DT, Westerbos SJ, Evans D, Land L, Vermeulen H. Topical negative pressure for treating chronic wounds. Cochrane Database of Systematic
Reviews 2008, Issue 3. Art. No.: CD001898. DOI: 10.1002/14651858.CD001898.pub2.

20. Dermatological Treatments
• Callus
– Diabetic shoes
• Ulceration
– VAC
– Debridement
– Dermal Skin Substitute
– Platelet Rich Plasma
Edwards J, Stapley S. Debridement of diabetic foot ulcers. Cochrane Database of Systematic Reviews 2010, Issue 1.

21. Dermatological Treatments
• Callus
– Diabetic shoes
• Ulceration
– VAC
– Debridement
– Dermal Skin Substitute
– Platelet Rich Plasma

22. Dermatological Treatments
• Callus
– Diabetic shoes
• Ulceration
– VAC
– Debridement
– Dermal Skin Substitute
– Platelet Rich Plasma

23. Dermatological Treatments
• Callus
– Diabetic shoes
• Ulceration
– VAC
– Debridement
– Dermal Skin Substitute
– Platelet Rich Plasma

24. Nerve Considerations
• Neuropathy
• Semmes Weinstein 5.07
monofilament (10g)
• EMG and NCV

25. Nerve Treatments
• Neuropathy
– Medication Oral
– Topical Medication
– ENFB (Epidermal Nerve
Fiber Biopsy)

26. Musculoskeletal Considerations
• Foot Deformities
• Plantar Pressure
• Charcot Joint

27. Musculoskeletal Considerations
• Foot Deformities
• Plantar Pressure
• Charcot Joint

28. Musculoskeletal Considerations
• Foot Deformities
• Gait Evaluation
• Plantar Pressure
• Charcot Joint

29. Musculoskeletal Treatments
• Foot Deformities
– Preventative foot
surgery

30. Vascular Considerations
• Pulses
• Capillary filling time
• Color changes
• Edema
• Temperature

31. Vascular Considerations
• Pulses
– Revascularization
– Silverhawk
– Vascular flaps

32. Shoegear Considerations
• Type of shoe
• Fit
• Lining Wear
• Insoles, Orthoses
• Socks

33. Shoegear Modifications
• Diabetic extra-depth
shoes
• Diabetic socks
• Multi-density inserts

34. Thank You
Don Pelto, DPM
Central Massachusetts Podiatry, PC
Worcester, MA
508.757.4003
don@worcesterfootcare.com