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New acronym to help guide foot ulcer treatment

A new paper has just published a simple acronym – MADADORE – to try and help busy clinicians remember what they need to do to treat diabetic foot ulcers (DFU).

The acronym was designed by Australian and Dutch researchers – Drs Peter Lazzarini, Mal Fernando and Jaap van Netten – “to assist GPs (and other primary clinicians) to quickly remember the (international) guideline-recommended DFU principles needed to manage a patient presenting with a DFU”.

MADADORE covers the first letter of 8 overarching evidence-based principles that clinicians should consider when managing a patient presenting with a DFU. The authors suggest each principle should be considered when a patient with a DFU presents, but some should only be performed by clinicians competent in that principle or if the patient’s DFU warrants it. Those 8 principles are:

  • Metabolic/Medication: Control any hyperglycaemia, hyperlipidaemia and hypertension
  • Assessment: Assess the DFU for PEDIS (perfusion, extent (size), depth, infection and sensation)
  • Debridement: Debride the DFU of debris, slough, necrotic and hyperkeratotic tissue
  • Antibiotics: Prescribe any antibiotics for the DFU based on diabetic foot infection severity
  • Dressing: Apply wound dressings to best absorb the DFU’s exudate levels
  • Offloading: Offload the DFU with a knee-high device to optimise plantar pressure reduction
  • Referral: Refer to a multidisciplinary diabetic foot team for best DFU management
  • Education: Educate the person with a DFU on self-care that aligns with the above principles

The authors strongly recommend after the initial presentation the patient should be urgently referred to a local multi-disciplinary diabetic foot team for shared care.

They summarise research showing that patients referred to such teams within 2 days of initial presentation have much better DFU outcomes, such as quicker healing, less infection, less hospitalisation and amputations. If no local multi-disciplinary diabetic foot team exists they go on to suggest which health professionals may be able to perform each principle and which Australian and international guideline to read for more detailed information on each principle.

And for National Diabetes Week we have turned MADADORE into an even simpler infographic to help people with DFU, their families and clinicians understand the treatments they may need for their DFU.

It’s also about time to book your DFA2019 Pass. We’re about 8 weeks away from taking over Howard Smith Wharves!  Five additional workshops and two breakfast workshops will also be released soon to our existing delegates to book in first – you don’t want to miss out!

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