Practice Points

• Ulcers need mechanical, wound, vascular, microbiological, metabolic and educational control

• Mechanical control consists of total-contact casts, Scotch-cast boots, crutches, wheelchairs, Aircasts, PRAFOs, custom-made walking AFOs, rest and elevation as appropriate

• Wound control involves sharp debridement and dressings and may need advanced wound healing products or supplementary treatments

• To obtain vascular control it is necessary to assess the vascular status of all ulcerated feet. Neuroischaemic feet may need vascular intervention

• To achieve microbiological control, neuroischaemic feet, burns and puncture wounds will need early antibiotic therapy

• Optimizing control of blood glucose, blood pressure and blood lipids and helping patients to stop smoking will achieve good metabolic control

• Educational control involves teaching patients the need for rest, debridement, regular dressings and early reporting of problems, and explaining how lifestyle changes can prevent relapse.

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