Management of Diabetic Foot Ulcers in Patients with Multiple Sclerosis

Core Management Principles

The American Diabetes Association recommends using a non-removable knee-high offloading device as first-line treatment for neuropathic plantar forefoot or midfoot ulcers to promote healing 1
For patients with limited access to specialized offloading devices, consider felted foam in combination with appropriate footwear 1
Sharp debridement should be performed as the standard of care, with frequency determined by clinical need, as recommended by the American College of Foot and Ankle Surgeons 2, 3
Basic wound dressings that absorb exudate and maintain a moist wound healing environment should be used, according to the Wound, Ostomy and Continence Nurses Society 3

The American College of Foot and Ankle Surgeons recommends considering hyperbaric oxygen therapy for neuro-ischemic or ischemic ulcers when standard care has failed and resources exist 3
Autologous leucocyte, platelet, and fibrin patch can be considered for diabetic foot ulcers as adjunctive therapy when standard care has been ineffective, as suggested by the American Diabetes Association 4
Negative pressure wound therapy can be considered as an adjunct therapy for post-surgical diabetic foot wounds, according to the Wound, Ostomy and Continence Nurses Society 4

The National Multiple Sclerosis Society recommends assessing MS-related mobility limitations when selecting offloading devices, as balance issues may make non-removable devices unsafe in some cases 1
For patients with significant mobility impairment, removable offloading devices with appropriate assistive devices should be considered, as suggested by the American Physical Therapy Association 1
Mild infections with plantar forefoot/midfoot ulcers can be treated with non-removable knee-high offloading devices, according to the Infectious Diseases Society of America 1

The American Diabetes Association recommends educating patients and caregivers about daily foot inspection, especially important for MS patients with sensory deficits 5, 6
Therapeutic footwear with demonstrated plantar pressure-relieving effect should be prescribed for healed plantar ulcers, as suggested by the American College of Foot and Ankle Surgeons 5
Home temperature monitoring can be used to identify early signs of inflammation, with instructions to reduce activity and seek care if temperature differences exceed 2.2°C between feet on consecutive days, according to the American Diabetes Association 5

Integrated foot care with professional assessment, adequate footwear, and structured education should be provided, as recommended by the American Diabetes Association 5
High-risk patients should be monitored every 1-3 months and moderate-risk patients every 3-6 months, according to the American College of Foot and Ankle Surgeons 5