Diabetic Foot Ulcers: Beyond the Evidence

There are five categories of diabetic foot ulcers (DFUs): 1- Chronic pressure (neuropathic)wounds which are usually painless, with callus at pressure site on pink feet with preserved pulses. 2-Ischemic wounds which are usually painful with bulla at tip of fingers on pulseless and purple feet. 3-Primary infectious wounds initiating usually below or between toes and are purulent and deep ulcers. 4-Traumatic wounds which may be on every location with different shapes (usually mimic human made objects) and 5-Atypical ulcers with unexpected location, presentation or behavior. There are four evidence-based and approved mandatory treatments for diabetic foot ulcers: 1-Stop ongoing trauma (relief of pressure and protection of the ulcer). 2-Restoration of skin perfusion. 3- Treatment of infection and 4-Adequate debridement. Metabolic control, treatment of comorbidities, psychologic support and education of patients and their relatives are also very important. Beyond these, some alternative options are presented and frequently advertised, e.g. hyperbaric oxygen, ozone therapy, stem cells, maggot therapy, special wound coverings, growth factors and platelets rich plasma.Here we are going to discuss the evidences beyond these alternative treatment options