Foundations of good ulcer care.

Diabetic foot ulcers are a significant healthcare problem affecting more than 1 million patients at some point in their lifetime. Good ulcer care begins with thorough assessment of the ulcer, which includes determining whether the ulcer is infected and whether neuropathy or peripheral vascular disease is present. The principles of good wound care include use of proper footwear, non-weight-bearing limb support, use of appropriate antibiotics, debridement, aggressive revascularization, control of serum glucose levels, and careful monitoring of the ulcer. For refractory ulcers, new therapies, such as the use of exogenous recombinant growth factors, are being developed that may have a significant benefit in treating these ulcers and lowering the amputation rate.