volve lifestyle changes such as dietary modifications, daily foot surveillance, appropriate foot hygiene, footwear and skin care (Table 2).4,5,18,19 Treatment of a patient with DFU can follow an algorithm called “VIPS,"18 to treat the cause of the ulceration. The abbreviation stands for: V = Vascular supply, which can be assessed by detecting a palpable foot pulse of ≥80 mmHg, an ankle-brachial pressure index (ABPI) of >0.5 and <1.3, a transcutaneous oxygen tension of >30 mmHg, and toe pressure of >55 mmHg. If the ABPI is >1.3, calcifications could be present indicating peripheral ischemic disease. The ABPI is to be followed by a full Doppler examination of the affected extremity, which may include the abdomen, to detect the extent of the disease and todefine the healing ability of the ulcer. 18
I = Inflammation and/or Infection treatment, in case there are clinical signs of an infection, such as erythema, edema, enhanced exudate production, pus, deterioration of the ulcer, and increased pain.18 However, in those patients with neuropathy, pain sensation may not be present and erythema and warmth may likewise not be as evident due reduced sympathetic arterio- lar tone due to the autonomic component of the neuropathy.18 Abnormal blood glucose values in patients that were previously well controlled may also indicate the presence of an infection.18
P = Plantar pressure redistribution and S = Sharp Surgical serial debridement.18
Early stages of DFS include dry skin, callus formation, hyper- keratosis. While they are relatively benign compared to DFU, these skin conditions can progress into skin infections or DFU if not treated appropriately. For instance, A defective skin barrier exposes the skin to water loss and to invasion of pathogens and may lead to dry/hyperkeratotic skin and inflammation.3-5,18,19
Callus formation is the body’s natural response to excessive friction and pressure; biomechanical factors may play a role in callus formation as does an abnormal gait.18-20
Hyperkeratosis in the patients with DFS can be prevented and managed by offloading and by suitable footwear, as well as by callus removal and pressure prevention (Figure 3).18-20 It is important to debride crusts, callouses, scabs, and scales, and to restore moisture balance of the skin, by using a gentle cleanser and moisturizer on a consistent basis. Appropriate care of the skin using gentle cleansers and moisturizers and early- stage treatment of skin-barrier dysfunction may help prevent complications in the patients with DFS.3-5,18-20 Utilization of rou- tine gentle cleanser and moisturizer may also help establish a durable barrier against further drying and irritation of the skin, preventing skin cracks, and infection.3-5,18-20
I = Inflammation and/or Infection treatment, in case there are clinical signs of an infection, such as erythema, edema, enhanced exudate production, pus, deterioration of the ulcer, and increased pain.18 However, in those patients with neuropathy, pain sensation may not be present and erythema and warmth may likewise not be as evident due reduced sympathetic arterio- lar tone due to the autonomic component of the neuropathy.18 Abnormal blood glucose values in patients that were previously well controlled may also indicate the presence of an infection.18
P = Plantar pressure redistribution and S = Sharp Surgical serial debridement.18
Early stages of DFS include dry skin, callus formation, hyper- keratosis. While they are relatively benign compared to DFU, these skin conditions can progress into skin infections or DFU if not treated appropriately. For instance, A defective skin barrier exposes the skin to water loss and to invasion of pathogens and may lead to dry/hyperkeratotic skin and inflammation.3-5,18,19
Callus formation is the body’s natural response to excessive friction and pressure; biomechanical factors may play a role in callus formation as does an abnormal gait.18-20
Hyperkeratosis in the patients with DFS can be prevented and managed by offloading and by suitable footwear, as well as by callus removal and pressure prevention (Figure 3).18-20 It is important to debride crusts, callouses, scabs, and scales, and to restore moisture balance of the skin, by using a gentle cleanser and moisturizer on a consistent basis. Appropriate care of the skin using gentle cleansers and moisturizers and early- stage treatment of skin-barrier dysfunction may help prevent complications in the patients with DFS.3-5,18-20 Utilization of rou- tine gentle cleanser and moisturizer may also help establish a durable barrier against further drying and irritation of the skin, preventing skin cracks, and infection.3-5,18-20
