Pedal ulcers in older adults with diabetes mellitus

Diabetes mellitus and its complications increase with aging, which can make the management of pedal ulcers a difficult challenge for the rehabilitatio n and wound specialist. To prevent infections and subsequent lower extremit y amputation, identification and healing of foot ulcers in older adults wit h diabetes should be a high priority for all rehabilitation and wound care specialists. This article reviews several potential impediments to pedal ul cer healing encountered in clinical practice for the older adult with diabe tes mellitus. Therapeutic strategies to heal and prevent plantar foot ulcer s are discussed. with particular emphasis on total-contact casting and othe r alternative off-loading strategies. Despite the often-held suspicion that wound healing is impaired in aging, this evidence suggests that healing ti me using total-contact casting is not impaired in older adults compared to younger adults with diabetes. Older adults with diabetes, however, appear t o be at higher risk for developing plantar ulcers and potentially for wound failure because of the more frequent presence of accompanying peripheral v ascular disease, foot deformity, and peripheral neuropathy.