What The Evidence Reveals About Midfoot Ulcers In Patients With Diabetes

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Author(s): 
Valerie Schade, DPM, AACFAS

Emphasizing The Need For Family Involvement And Multidisciplinary Teamwork

The treating physician should involve the patient’s family and support network in these discussions so they are also aware of what treatment entails. One should also discuss ease of accessibility of a wheelchair, walker, crutches, etc., in the patient’s home and potentially his or her place of employment. Does the patient need to use any stairs? Are all areas where the patient must go wheelchair accessible?

   A consult to physical therapy can be beneficial in having these patients properly trained in the safe use of assistive ambulation devices to maintain their weightbearing restrictions safely. One should consider short postoperative hospitalization in patients who have extensive surgical intervention. Hospitalization ensures patient safety postoperatively and reinforces proper techniques for non-weightbearing and antithrombotic prophylaxis if patients use prophylaxis in the postoperative period.

   The podiatric physician should consider consults with wound care clinics, physical therapy, social work and rehabilitation or skilled nursing facilities during the postoperative recovery of these patients for optimal patient care.

   Dr. Schade is the Chief of the Limb Preservation Service and Director of the Complex Lower Extremity Surgery and Research Fellowship at Madigan Healthcare System in Tacoma, Wash. She is an Associate of the American College of Foot and Ankle Surgeons.

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