Identifying and treating foot ulcers in patients with diabetes

     saving feet, legs and lives


There has been a great deal of debate around diabetic foot ulcers (DFUs) and pressure ulcers (PUs) on the feet of patients with diabetes, in terms of how to define, detect, assess and treat them. The confusion and lack of evidence in differentiating between these two types of foot ulcers, particularly on the heel, can lead to misdiagnosis, which can increase both financial and patient-related costs.


To address and tackle those inconsistencies, the Journal of Wound Care (JWC) has published its first international consensus document, Identifying and treating foot ulcers in patients with diabetes: saving feet, legs and lives. The main objectives of this project were to:

  • Provide information on the differences between a DFU and a PU in patients with diabetes

  • Help reduce misdiagnosis by providing and discussing assessment guidelines

  • Make a difference in practice through improved patient outcomes.


With this in mind, an international panel of ten key opinion leaders from Australia, England, Republic of Ireland, Malaysia, Poland, Portugal, Spain, United Arab Emirates and US met on 1 and 2 March 2018 in London. They discussed the definitions of a DFU and a PU, and concluded that one way to distinguish between them is knowing whether the patient is mobile (usually associated with DFUs) or immobile (normally related to PUs), although this should be considered along with simple assessments for ischaemia and neuropathy. To this end, and given the importance of an early and correct assessment, the mnemonic ‘VIPS’ was suggested:

  • V: vascular (ischaemia)

  • I: infection (local signs, odour, exudate, slough, inflammation, etc.)

  • P: pressure (causes mobility or immobility)

  • S: sensation (neuropathy).

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