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  1. Orsted, Heather L. RN, BN, ET, MSc
  2. Searles, Gordon E. OD, MD, MSc, FRCPC (IM and Derm), FACP, FAAD, CPI
  3. Trowell, Heather BSC, OT(c)
  4. Shapera, Leah RN, MSN, IIWCC, GNC
  5. Miller, Pat RN, ET
  6. Rahman, John CO(c)


PURPOSE: To provide the specialist in skin and wound care with evidence-based guidelines for care of the person with a diabetic foot ulcer.


TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in wound care and related disorders.


OBJECTIVES: After reading this article and taking this test, the reader should be able to:


1. Describe the pathophysiology, assessment, and diagnostic techniques related to diabetic foot ulcers.


2. Identify current, evidence-based preventative and treatment options for the diabetic foot ulcer.



Editor's note: This "Best Practice Recommendations" article is reprinted with permission from Wound Care Canada, The Official Publication of the Canadian Association of Wound Care (2006;4[1]:57-71). It is the final installment of 4 articles originally published in 2006, following the latest Nursing Best Practice Guidelines from the Registered Nurses Association of Ontario (RNAO), which are updated approximately every 3 years. In 2000, the Canadian Association of Wound Care produced and had published its first best practice recommendations for the prevention and treatment of pressure ulcers.


In this article, the best practices focus on the clinical aspects of care relating to the education of both clinician and patient. Care components include assessing for, and the removal of, factors that can affect healing, as well as the delivery of adequate vascular supply, infection control and pressure downloading, and the provision of an optimal local wound environment. The adequate delivery of care requires an interprofessional team approach to provide coordinated and integrated management. The article is meant to provide a practical, easy-to-follow guide or bedside enabler, based on the best available evidence, to support the wound-care clinician and team in planning and delivering the best clinical practice related to diabetic foot ulcers.


However, this article is not meant to be comprehensive. The RNAO guidelines offer the clinical directions for practice based on the level of evidence, as well as a challenge to "go one step further" and review what is required to implement the clinical aspect of practice by addressing educational and organizational recommendations to support best clinical practice.