Diabetic foot ulcersBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7538.407 (Published 16 February 2006) Cite this as: BMJ 2006;332:407
All rapid responses
In the management of diabetic foot ulcers, Edmonds and Foster have
rightly highlighted the broad management by dividing the headings into
five groups of wound control, mechanical control, vascular control,
microbiological control and metabolic control.1 Similar points are
covered, albeit differently, in most related publications by experts.2-5 I
will like to emphasized the importance of one more aspect, i.e. timely
swelling control, in the management of any foot ulcer or wound in diabetes
particularly by General Practitioner.
People with diabetes are prone to develop swelling of feet due to
various related or unrelated conditions, like gravitational effect,
varicose vein, renal, cardiac, or hepatic decompensation, drugs like
calcium channel blockers etc. Any minor injury may also be associated with
some degree of oedema. Swelling interferes with apposition of the edge,
impairs with healing of wound and promotes spread of infection. In this
way, swelling may delay the healing of even a minor injury or ulcer,
inviting further complications and vicious cycle. Thus, while managing
such patients in the Diabetes and Endocrinology Clinic, I have learned the
importance of giving attention to the oedema right from the early stage of
any foot trauma or wound in diabetes. So when any patient with diabetes
comes with foot ulcer, I also particularly look for the presence of oedema
and if required, control it with elevation of the limb or the use of
diuretics if indicated for other associated condition. Otherwise a minor
injury may easily and rapidly turn into a major problem, leading to
unnecessary suffering and cost. Elevation of the limb is usually discussed
to manage wound when obvious swelling is present.2-5 But timely
consideration of the minimal swelling, particularly by General
Practitioner, even from the beginning of any wound in foot in diabetes is
1. Edmonds ME, Foster AVM. ABC of wound healing: Diabetic foot
ulcers. BMJ 2006; 332: 407-10.
2. Watkins PJ. ABC of diabetes: The diabetic foot. BMJ 2003; 326: 977
3. The International Working Group on the Diabetic Foot.
International consensus on the diabetic foot. 2003.
4. American Diabetes Association. Medical management of type 2
diabetes. 2004: 114-22.
5. Ganchi PA, Eriksson E. Diabetes mellitus and wound healing. In:
Kahn CR, Weir GC, King GL, Jacobson AM, Moses AC, Smith RJ, eds. Joslin's
diabetes mellitus. 14th ed. Philadelphia: Lippincott Williams and Wilkins,
Competing interests: No competing interests