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Diabetic foot ulcer — MCCQE Part 1 MCQ

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ModerateSkin LesionsDiabetic foot ulcerMCCQE Part 1

A 68-year-old with type 2 diabetes has a painless 1.8-cm ulcer beneath the first metatarsal head. It extends through the skin but does not probe to bone. There is callus and loss of monofilament sensation, but no purulence, erythema or systemic illness. Pedal pulses are palpable and the ankle-brachial index is 0.94. What is the best initial treatment?

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Correct answer: A — Debride and dress the ulcer and use a non-removable knee-high offloading device

This is an uncomplicated neuropathic plantar forefoot ulcer: protective sensation is lost, perfusion is adequate and there is no clinical infection or evidence of deep bone involvement. Initial care combines callus and wound debridement, an appropriate moist dressing, pressure redistribution—preferably with a non-removable knee-high device such as a total-contact cast when safe—and multidisciplinary follow-up. Antibiotics do not improve an uninfected ulcer and create avoidable harm. MRI and prolonged intravenous therapy are reserved for suspected deep infection or osteomyelitis. Hyperbaric oxygen is not a substitute for standard wound care and offloading. Revascularization is considered when clinically important ischemia is present, which the palpable pulses and ankle-brachial index do not suggest here.

Reference: Diabetes Canada Foot Care Guideline: https://guidelines.diabetes.ca/cpg/chapter32