Point of care ultrasound imaging as a wound assessment tool in diabetic foot ulcers : a case series

Foot ulceration is a common and devastating complication of diabetes. Traditionally, diabetic foot ulcers (DFU) are managed by multidisciplinary teams in tertiary hospital settings. Wound management decisions are based largely on visual observations at the point of care, using rudimentary evaluation of superficial tissues, such as wound tracings and photography combined with expert knowledge of the treating practitioners. Imaging based methods of assessment, such as X-ray, magnetic resonance imaging, scintigraphy or computed tomography are able to more comprehensively categorise wounds and to determine whether re-epithelialised wounds are in fact healed. Ultrasound has been advocated by the World Health Organization for the monitoring of chronic diseases and for screening because it is considered low risk, comfortable for patients and low cost. It can be performed in real time at the point of care and using B-mode, Doppler and elastography has the potential to provide clinically meaningful information for monitoring the status of hard-to-heal wounds, but to date this imaging technique has not been exploited in this field. This case series highlights the utility of diagnostic musculoskeletal ultrasound as an adjunct to traditional wound assessment that can provide diagnostically meaningful information to assist in clinical decision making. Future research will be needed to determine if routine incorporation of ultrasound in wound assessment improves patient outcomes