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Get quick tips that you can use in daily practice from Advances in Skin & Wound Care's Clinical Associate Editors, R. Gary Sibbald, BSc, MD, FRCPC (Med) (Derm), FAPWCA, MEd, and Elizabeth A. Ayello, PhD, RN, APRN, BC, CWOCN, FAPWCA, FAAN.


This month's clinical practice tip is on treating patients with neuropathic foot ulcers. Keep this handy for an easy reminder.

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VIPS for Neuropathic Foot Ulcers: 20-second enablers for practice*

Diabetes mellitus is a major health problem worldwide. As more persons are developing diabetes mellitus at an earlier age, the incidence of complications from this chronic disease will likely increase. Fifteen percent of persons with diabetes will have an ulcer.1 Saving limbs is important for persons with diabetes. Eighty-five percent of persons with diabetes have lower extremity amputations (LEA) that are preceded by a foot ulcer.2 Persons with diabetes account for about 60% of all LEAs in the United States.2 Preventing neuropathic ulcers is important, of course, but if one does occur, prompt and accurate treatment is paramount to save the patient's limb.


An easy way of remembering an effective approach to treating persons with neuropathic foot ulcers is through the use of the mnemonic VIPS.3 To most people, VIPS represents "very important persons," but for wound care clinicians, it means adequate Vascular supply, Infection control, Pressure offloading, and the use of Sharp Surgical debridement for hyperkeratatic surrounding callus and the surface slough of the wound bed.

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Vascular supply must be adequate for a chronic wound to heal. If the pulse is not palpable, the clinician should perform other studies, such as those outlined below, at the bedside or in the noninvasive vascular laboratory. Ankle-brachial pressure ratios may be falsely elevated in persons with diabetes due to calcification of the arterial vessel wall. For this reason, clinicians should use transcutaneous oxygen saturation or toe pressures to confirm vascular status. Any patient without a palpable foot pulse (dorsalis pedis or posterior tibial artery) should have a full duplex leg Doppler to identify potentially bypassable or dilatable lesions that should improve peripheral arterial perfusion. In addition to the vascular supply, a neuropathic foot wound should be free of infection and should have adequate pressure offloading with one of the options listed in the table, along with regular surgical debridement if enough adequate blood supply for healing is present.




1. Centers for Disease Control and Prevention. History of foot ulcer among persons with diabetes-United States, 2000-2002. MMWR Morb Mortal Wkly Rep 2003;52(45):1098-102. [Context Link]


2. Palumbo PJ, Melton LJ. Peripheral vascular disease and diabetes. In Diabetes in America: Diabetes Data Compiled 1984. Washington, DC, US Government Printing Office. NIH Publication No. 85-1468, 1-21, 1985. [Context Link]


3. Orsted HL, Searles GE, Trowell H, et al. Prevention diagnosis and treatment of diabetic foot ulcers. Wound Care Canada; Spring 2006. [Context Link]