[Foot Ulcers in Orthopedics].

Abstract

Introduction: Foot ulcers are most often vascular, pressure-related or diabetes-related. The presence of neuropathy with loss of protective sensation and/or peripheral arterial disease are essential risk factors for diabetic foot ulcers. Prevention aims at identifying the foot at risk, regularly checking the foot at risk, educating patients, relatives and healthcare professionals, ensuring the routine wearing of appropriate footwear and treating risk factors for ulceration. In the presence of a diabetic foot ulcer, therapy consists of a combination of mechanical relief (gold standard during the ulcer phase: total contact cast), treatment of peripheral arterial disease, treatment of infections, metabolic control and treatment of comorbidities, local ulcer control and education of patients and relatives. Infected ulcers must be examined for the presence of osteomyelitis. Without osteomyelitis, therapy consists of local debridement and 1-2 weeks of antibiotic therapy. If osteomyelitis is present, therapy consists either of a combination of surgical therapy (amputation vs. internal resection) with accompanying short antibiotic therapy or of purely conservative therapy with 6 weeks of antibiotics. After the ulcer has healed, orthopedic shoe care is indicated to prevent recurrence.