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Diabetic Foot Files

Diabetic Foot Files

 THE DIABETIC FOOT FILES HAS A NEW HOME! 

The brand-new Diabetic Foot Files website is LIVE!  

Welcome to the digital home of everything diabetic foot, wound care, limb salvage, and beyond. From the latest podcast episodes and expert conversations to LIMBWatch, educational content, and resources for the limb-salvage community — it’s all coming together in one place.

 www.diabeticfootfiles.com

Whether you’re a clinician, researcher, student, patient, advocate, or simply passionate about saving limbs — there’s a place for you here.

 Listen.
 Learn.
 Think beyond the wound.
 Save the limb. Change the life.

Welcome to the next chapter of Diabetic Foot Files. 

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Welcome to the Diabetic Foot Files Podcast and the LIMBWatch series — where diabetic foot surveillance, wound intelligence, prevention science, and limb preservation come together. I’m Dr. G / Dr. WoundPicasso aka Dr. Gabrielle Hutcheson Donaldson, podiatrist and wound care specialist, and I’m here to educate, empower, and guide you through the evolving world of diabetic foot care.

From wound healing and pressure injuries to surveillance systems and amputation prevention, we break down the science, challenge the myths, and share strategies that help save limbs and improve lives. Whether you’re a patient, caregiver, clinician, or healthcare professional, this is your destination for diabetic foot education, prevention, and preservation.

So let’s dive in — because when you take care of your feet, they take care of you.
LIMBWatch: Surveillance Before Salvage- World Leaders in LIMB Salvage 

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  • S1 · E1
    Yesterday · 49 min

    LIMBWatch Series: Dr. Jared Adams MD,PhD : Your Story Could Save a Limb: Inside the New Diabetic Foot Ulcer Patient Registry STEADY

    Your Story Could Save a Limb: Inside the New Diabetic Foot Ulcer Patient Registry What if the most important piece of diabetic foot ulcer research isn’t another clinical endpoint—but the patient’s story? In this special episode of LIMBWatch, Dr. G sits down with Dr. Jared Adams, Senior Vice President of Global Medical Affairs, Digital, and Technology at Alira Health, to explore a powerful new approach to diabetic foot ulcer research: building a patient-centered registry that follows the real-world story of people living with DFUs. A diabetic foot ulcer is never “just a wound.” It can affect mobility, employment, sleep, mental health, independence, finances, transportation, family members, and the ability to access care. Yet many of those experiences never make it into the medical record. Dr. Adams explains why registries can fill that gap by connecting patient-reported experiences, clinical information, wound images, healthcare records, and eventually claims data to create a much more complete picture of what actually happens to people living with DFUs. Together, Dr. G and Dr. Adams discuss why clinical trials and real-world evidence serve different purposes, why the patients seen in everyday practice often look very different from carefully selected clinical-trial populations, and how understanding the entire pathway of care may help identify opportunities to intervene before a patient reaches hospitalization, recurrence, or amputation. One of the most powerful themes of the conversation is co-design. Patients aren’t simply being asked to participate in research—they are being invited to help determine what the research should ask in the first place. The registry team is currently conducting remote, compensated one-hour interviews with people living with diabetic foot ulcers to learn what researchers may be missing. Participants can share everything from how their ulcer began and how their care was coordinated—or fragmented—to the emotional, financial, and practical realities that don’t appear in a wound measurement. And compensation matters. As Dr. Adams explains, patients are being compensated because lived experience is expertise. Their time, knowledge, and experiences have value. These interviews are separate from enrollment in the registry itself. The goal is to listen first, learn from patients, and use those insights to help build a registry capable of following thousands of people over many years. The conversation also explores the potential of smartphones, AI, remote monitoring, and patient-generated data to become part of the future wound-care toolkit—but with an important reminder: technology cannot replace the human being in the loop. Perhaps the most important message of the episode is this: Every toe has a story. And behind every wound is a person. If we can capture those stories, connect them to clinical evidence, and understand the pathways that lead toward healing—or toward limb loss—we may be able to move from simply treating diabetic foot ulcers to truly understanding them. From surveillance before salvage to fragmentation of care, insurance barriers, patient-reported outcomes, quality of life, limb preservation, and the future of real-world evidence, this episode asks a fundamental question: What could happen if we finally started measuring what matters most to the people living with diabetic foot ulcers? If you or someone you know is living with a diabetic foot ulcer and would like to learn more about participating in the patient interviews, visit STEADY DFU Patient Registry Your story may reveal the question researchers didn’t know they needed to ask. Your voice matters. And it could help change what happens to the next patient. Correction: The episode incorrectly stated that US citizenship is required for participation in STEADY. US residency is required, but US citizenship is not required. Citizenship status is not asked or checked. All adult US residents with at least one active diabetic foot ulcer are encouraged to participate.

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    August 24 · 41 min

    LIMBWatch Series: Dr. Sukoff, Dr. Hanley & Dr. Warren - LIMBWatch: From Chronic Wound to Limb Preservation — The Science Behind Lavior

    Episode Summary In this episode of LIMBWatch, we go beyond the wound itself to explore the science, clinical challenges, and innovations shaping the future of limb preservation. We are joined by the team behind Lavior, including biomedical scientist and Chief Scientific Officer Dr. David Warren, wound care and hyperbaric medicine specialist Dr. Hanley, wound care podiatrist Dr. Sukoff, and National Sales Director Ashlyn Tapley. The conversation explores how Lavior was inspired by the healing properties of Inula viscosa, a medicinal plant with centuries of traditional use, and how the company developed a bioengineered hydrogel designed to address key challenges in chronic wound healing. We dive into the inflammatory phase of wound healing, antimicrobial and anti-inflammatory activity, bioactive compounds, wound-bed preparation, diabetic foot ulcers, surgical wounds, burns, pressure injuries, venous ulcers, and other complex wounds. The discussion also examines how Lavior is being used alongside negative pressure wound therapy, collagen, alginate, skin substitutes, PRP, total contact casting, and other wound-care modalities. Importantly, this episode goes beyond any single product. We discuss the fundamentals that remain critical to limb preservation: early intervention, vascular assessment and revascularization when necessary, meticulous wound-bed preparation, infection and biofilm management, moisture balance, and—perhaps most importantly—offloading. The episode also explores where wound care may be headed over the next decade, including new Lavior formulations incorporating collagen and calcium alginate, and the growing need for clinicians who understand chronic wounds and amputation prevention. And in one of the episode’s most memorable moments, Dr. Hanley shares a powerful message for people living with diabetes: “You can either have diabetes, or it can have you.” From the science of chronic inflammation to the human impact of amputation, this episode asks an essential LIMBWatch question: How early can we intervene—and what can we do differently to preserve the limb before the wound becomes a life-changing event? Episode Description Chronic wounds don’t just threaten skin—they can threaten mobility, independence, quality of life, and ultimately the limb. In this episode of LIMBWatch, we sit down with the Lavior team to explore a different approach to chronic wound healing and limb preservation. We discuss the science behind Lavior’s Inula viscosa-derived technology, its proposed antimicrobial and anti-inflammatory properties, the role of chronic inflammation in stalled wounds, and how the product is being incorporated into the management of diabetic foot ulcers and other complex wounds. We also tackle the clinical realities that matter beyond any dressing: early intervention, wound-bed preparation, vascular status, offloading, infection control, and multidisciplinary limb-salvage care. From diabetic foot ulcers and surgical wounds to ischemic wounds, pressure injuries, burns, and difficult-to-heal wounds, this conversation examines where innovation may fit into modern wound care—and where the fundamentals of limb preservation remain non-negotiable. Because saving a limb doesn’t start at amputation. It starts much earlier. 🎙️ LIMBWatch | Diabetic Foot Files This episode is for educational purposes and does not constitute medical advice or an endorsement of any specific product. Clinical decisions should be based on individual patient assessment and the available evidence.

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    August 23 · 27 min

    Copper: A Surprising Possible Ally in Diabetic Foot Ulcer Healing

    In this episode of Diabetic Fit Files Dr. G explores how the trace element copper affects diabetic foot ulcers at the cellular and molecular level. Topics include copper's roles in angiogenesis, collagen cross-linking via lysyl oxidase, fibroblast signaling, antimicrobial and anti-biofilm effects, and the promise of controlled copper delivery systems like hydrogels and nanoparticles. The episode stresses that copper is multifunctional but not a standalone cure: clinical healing depends on addressing vascular, mechanical, and infectious factors as part of a comprehensive limb-salvage approach.

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    August 22 · 27 min

    Reflexes, Tuning Forks & Monofilaments: Inside the Diabetic Foot Exam

    This episode breaks down the neurological exam of the diabetic foot, explaining reflexes, vibration testing, monofilament assessment, proprioception, pinprick and temperature testing, and the autonomic changes that lead to dry skin and fissures. It shows how different nerve fibers produce paradoxical symptoms, why loss of protective sensation causes silent injuries and ulcers, and why podiatry, vascular assessment and offloading are essential for limb preservation.

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    August 21 · 17 min

    “I Have a Diabetic Foot Ulcer… But I Don’t Have Insurance. Now What?”

    This episode explains what to do if you have a diabetic foot ulcer and no health insurance, stressing that you should not ignore the wound or try to self-treat. It covers signs of infection, the need for vascular checks and offloading, and when to seek emergency care. It also outlines practical options for uninsured patients—community health centers, sliding-fee clinics, hospital charity care—and simple home measures to protect the foot while you arrange professional evaluation.

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    August 19 · 21 min

    SMAPs: Rethinking Antimicrobials for Diabetic Foot Care

    This episode explores SMAPs — synthetic mimics of antimicrobial peptides — and how they use membrane-targeting chemistry to kill bacteria differently from conventional antibiotics. It covers the science behind facial amphiphilicity, selectivity versus toxicity, challenges like biofilms and stability, and the potential role of SMAPs as future adjunctive topical therapies for diabetic foot ulcers, while emphasizing they remain experimental and not yet clinical standard of care.

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    August 17 · 48 min

    LIMBWatch Series: Dr. Shilpa Rajan Mulki- Look at Your Feet Before You Sleep: Saving Limbs in Resource-Limited Settings

    🎙️ Diabetic Foot Files: Limb Watch with Dr. Shilpa Rajan Mulki What if some amputations could be prevented simply by recognizing the warning signs sooner? In this episode of Diabetic Foot Files: Limb Watch, Dr. Gabrielle sits down with Dr. Shilpa Rajan Mulki, a diabetologist and diabetic foot and wound-care specialist practicing in Nairobi, Kenya, for a powerful conversation about limb preservation, prevention, and the gaps that can stand between a patient and saving their limb. Dr. Mulki shares her personal journey into diabetic foot care and explains why multidisciplinary treatment changed the way she approaches complex wounds. Together, they discuss the warning signs of neuropathy and peripheral arterial disease, why so many patients never receive proper foot screening, and how small missed opportunities can eventually lead to devastating complications. The conversation goes beyond the wound itself—exploring offloading, infection and antibiotic misconceptions, nutrition, biomechanics, skin-tone differences in assessment, referral pathways, healthcare access, telemedicine, clinician education, and the importance of building multidisciplinary teams that actually work together. Most importantly, this episode asks a bigger question: Are we doing enough to prevent diabetic foot complications—or are we waiting until the limb is already in danger? Dr. Mulki message is one every person living with diabetes, caregiver, nurse, physician, and healthcare professional should hear: Look at your feet. Recognize the warning signs. Act early. Save the limb. Because limb preservation doesn't begin in the operating room. It begins with prevention

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    August 16 · 36 min

    The Toe That Killed Jack Daniel: The Untold Medical Story

    A man who built a global whiskey empire may have been felled not by drink or duel but by a small foot injury that turned infected. This episode examines the legend of Jack Daniel’s toe, the historical accounts of gangrene and “blood poisoning,” and what modern medicine would call sepsis. Beyond the mystery, the episode delivers a clear medical lesson: tiny wounds can become life-threatening without prompt podiatric and vascular care. Learn why early attention to foot injuries matters and how today’s treatments could have changed the outcome.

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    August 15 · 19 min

    Understanding Undermining- Unseen, unexpected and unforgiving : The Truth Behind “Doctor Made My Wound Bigger” — Understanding Undermining

    This episode explains undermining in diabetic foot ulcers—how tissue destruction can extend beneath intact skin, why wounds may appear larger after debridement, and what that means for healing. We cover the causes (pressure, neuropathy, ischemia, infection), clinical clues, why proper assessment and debridement matter, and practical prevention tips like offloading, vascular care, infection control, and good diabetes management.

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    August 15 · 22 min

    Teeth in the Tide- When the Ocean Bites: Barracuda Strike and Diabetic Foot Danger

    In this episode Dr. G recounts a surprising barracuda bite that exposes the challenges of marine injuries, especially for people with diabetes. The episode explains how sharp lacerations, contamination from seawater, retained debris, and organisms like Vibrio can turn a beach wound into a serious infection. Key takeaways include immediate bleeding control and irrigation, careful wound assessment (tendons, bone, foreign bodies, tetanus status), cautious use of closure and targeted antibiotics, and the importance of early medical attention — particularly for patients with neuropathy or impaired healing.

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    August 15 · 33 min

    Forgotten Infection Friday- Madura Foot: The Silent, Years-Long Infection Hiding in Plain Sight

    This episode reviews Madura foot (mycetoma), a chronic implantation infection characterized by long-standing swelling, multiple sinus tracts, and visible ‘‘grains.’p> There are two main types — eumycetoma (fungal) and actinomycetoma (bacterial) — with different treatments (antifungals ± surgery vs prolonged antibiotics). Diagnosis relies on deep tissue sampling, culture, histology and imaging to define extent. Early recognition, protective footwear, and daily foot checks are key to limb preservation, especially in patients with diabetes and neuropathy.

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    August 10 · 46 min

    LIMBWatch Series: Dr. Andrew JM Boulton, MD, DSc (Hon), FACP, FICP, FRCP-The Man Who Changed Diabetic Foot Care Dr. Andrew Boulton on Neuropathy, Prevention & Saving Limbs Worldwide

    Welcome to LIMBWatch — the global movement dedicated to protecting limbs, preventing amputations, and transforming the future of diabetic foot care. In this landmark episode, we welcome one of the world’s most influential leaders in diabetes and diabetic foot disease — Dr. Andrew Boulton, a pioneer whose research, leadership, and advocacy have shaped modern approaches to neuropathy, diabetic foot screening, and limb salvage. With more than 600 peer-reviewed publications, an H-index exceeding 130, and decades of international leadership including roles with global diabetes organizations, Dr. Boulton shares lessons from a lifetime dedicated to one mission: preventing unnecessary amputations and improving the lives of people living with diabetes worldwide. In this powerful conversation, Dr. Boulton discusses: 🦶 Why diabetic neuropathy can remain silent until it is too late 🦶 The life-changing importance of annual diabetic foot screening 🦶 Why “take off the shoes and socks and look at the feet” remains one of the most powerful tools in medicine 🦶 The misconception that amputation is an inevitable outcome of diabetic foot disease 🦶 How multidisciplinary foot teams can transform limb salvage outcomes 🦶 Why prevention must become the future of diabetic foot care 🦶 The role of AI and technology in identifying high-risk patients 🦶 Why evidence-based medicine is essential for advancing wound healing treatments 🦶 The overlooked importance of footwear, offloading, biomechanics, and patient-centered care 🦶 The future of global diabetic foot initiatives and making limb preservation accessible everywhere Dr. Boulton also shares personal reflections from his career, including lessons learned from patients, his admiration for pioneers like Dr. Paul Brand, and why the greatest reward in medicine is not financial success — but the ability to change lives. His message is clear: Diabetic foot complications are preventable. Screening saves limbs. Early intervention saves lives. This episode is a must-listen for healthcare professionals, patients, researchers, policymakers, and anyone committed to building a future where amputations become less common and limb salvage becomes the global standard. This is LIMBWatch — because every limb matters.

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    August 9 · 22 min

    Antimicrobial ≠ Antibiotic: Antimicrobial Doesn’t Mean Antibiotic

    This episode clarifies the difference between antimicrobials (agents that act against a range of microorganisms) and antibiotics (drugs that specifically target bacteria), and explains related terms like antiseptics, contamination, colonization, and infection in diabetic foot ulcers. Dr. G reviews when topical antimicrobial dressings are appropriate, why they do not automatically replace systemic antibiotics, and how debridement, source control, and wound biology guide treatment decisions. Key takeaways focus on evaluating the wound, understanding product mechanisms, avoiding unnecessary antibiotics through stewardship, and choosing interventions that help heal the patient and protect the limb.

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    August 8 · 21 min

    Why Your Healed Wound Still Feels Tight — What Causes Tight Skin After Diabetic Foot Wounds

    This episode explains why healed wounds can feel tight, covering the stages of wound healing, the role of myofibroblasts and alpha-SMA in wound contraction, and how scar tissue differs from normal skin. It discusses how diabetes alters healing, the long remodeling phase (months to over a year), practical care tips like moisturization and follow-up, and warning signs that require prompt medical attention.

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    August 7 · 19 min

    Forgotten Infection Friday: Rhodococcus equi — The Macrophage‑Hiding Threat

    This episode explores Rhodococcus equi — a pink, soil‑associated bacterium historically linked to horses that can survive inside macrophages and mimic tuberculosis in the lungs. Dr. G discusses its discovery, how humans become exposed, diagnostic clues (culture, MALDI‑TOF, PCR), challenges in treatment (intracellular survival, prolonged combination antibiotics, and need for surgical source control), and its importance in immunocompromised and diabetic foot wound patients.

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    August 6 · 24 min

    Diabetic Foot Ulcers Aren’t Paper Cuts: When Triple Antibiotic Is Not Enough

    This episode traces the history and science behind triple antibiotic ointment—its three ingredients (bacitracin, neomycin, polymyxin B), how they attack different bacteria, and why it became a household staple for minor cuts. It explains why diabetic foot ulcers are fundamentally different from everyday wounds—driven by neuropathy, poor blood flow, chronic inflammation, biofilm, and deeper infection—and why a topical ointment cannot address these underlying problems. The episode also covers risks of using ointment on diabetic ulcers (maceration, contact dermatitis, altered wound microbiome), the difference between colonization and infection, and the importance of prompt medical assessment, vascular evaluation, offloading, debridement, glucose control, and specialized wound care.

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    August 3 · 42 min

    LIMBWatch Series: Dr. Thomas Hardiman- 10-Gram Truth: How a Simple Monofilament Saves Feet

    Episode Title: The 10-Gram Test That Can Save a Limb: Understanding Monofilament Screening, Neuropathy & Prevention with Dr. Thomas Hardiman Episode Summary: What if one of the simplest tools in diabetic foot care could help prevent devastating complications before they happen? In this powerful episode of LIMBWatch on Diabetic Foot Files, Dr. Gabrielle Donaldson sits down with Dr. Thomas Hardiman, a podiatric surgeon with over 40 years of experience in foot and ankle care and a pioneer in diabetic foot screening through his work with medical monofilament technology. Together, they take a deep dive into the science, history, and clinical importance of the 10-gram monofilament examination — a simple yet powerful tool used to identify loss of protective sensation (LOPS) and help recognize patients at risk for diabetic foot ulcers and amputations. Dr. Hardiman reveals the fascinating story behind the development of the monofilament, from early sensory testing pioneers to the influence of Dr. Paul Brand’s groundbreaking work, and explains why prevention starts by “going upstream” rather than waiting until patients present with wounds. In this episode, you’ll learn: 🦶 How the 10-gram monofilament actually works and what is happening at the nerve level when sensation is lost 🧬 How chronic hyperglycemia damages nerves through metabolic pathways, myelin injury, and impaired sensory signaling ⚠️ Why neuropathy is not simply “numbness” — but the loss of the body’s protective alarm system 🔍 Why a patient can have a normal monofilament exam and still remain at risk for ulceration 🎵 The difference between monofilament testing, vibration perception testing, and tuning fork examinations 📋 The correct technique, anatomical testing sites, and common mistakes clinicians make 🦠 Why single-use monofilaments matter for accuracy and infection prevention 👟 The importance of examining footwear and how a hidden foreign object can lead to a recurring ulcer 🤖 How artificial intelligence may transform diabetic foot surveillance and help identify high-risk patients earlier ❤️ Why patient education, daily foot inspections, and prevention remain some of the most powerful limb-saving interventions Dr. Hardiman shares unforgettable clinical lessons, including a patient whose heel ulcer repeatedly returned because a nail hidden inside his shoe was causing repeated trauma — a reminder that sometimes the most important diagnostic tools are simply looking, listening, and paying attention. He also challenges the healthcare community to rethink the phrase “silent epidemic,” explaining why diabetic foot complications are not silent and why calling them that may unintentionally create acceptance instead of urgency. His message to patients is clear: “Your feet should last a lifetime, and with proper care, they can.” This episode is a reminder that limb preservation does not always begin with the newest technology. Sometimes it begins with mastering the fundamentals, performing them consistently, and empowering patients before the first ulcer ever develops. Join us for an eye-opening conversation about neuropathy, prevention, screening, and the simple test that can help change the future of diabetic limb health. Key Takeaway Quote: “We don’t sell monofilaments. We partner in prevention.” — Dr. Thomas Hardiman 🦶 A 10-gram filament can change the future of a limb. Before a diabetic foot ulcer appears, there may be a silent warning sign: loss of protective sensation. Dr. Hardiman, Medical Director of Medical Monofilament, explains why proper monofilament testing matters — helping clinicians identify the “foot at risk” and take action before a small problem becomes a devastating complication. The right tool. The right technique. The right time. Learn more about Medical Monofilament technology: 🔗 https://www.medicalmonofilament.com

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    August 2 · 23 min

    The evolutionary purpose of diabetic neuropathy & Why Our Alarm System Fails in the Modern World and How The Healthcare System becomes that External Warning System for the Patient

    This episode explores why pain evolved as a critical protective alarm and how diabetes—through chronic high glucose, inflammation, and microvascular damage—silences that alarm by injuring peripheral nerves. It explains the biological pathways behind diabetic neuropathy, why the feet are especially vulnerable, how repetitive pressure and biofilm-forming bacteria turn painless injuries into ulcers, and the stepwise cascade from nerve damage to amputation. The episode emphasizes prevention and the clinician’s role as an external warning system: early screening, offloading, proper footwear, glucose control, vascular assessment and coordinated limb-salvage care to protect patients’ feet.

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    August 1 · 14 min

    Gossypiboma: The Hidden Sponge Sabotaging Wound Healing

    This episode explains gossypiboma (retained surgical sponge), how the body mounts a foreign‑body granuloma response, and why these sponges can mimic infection or tumors and lead to chronic inflammation. It highlights the added danger for people with diabetes (impaired immunity, poor circulation, neuropathy), shares a real diagnostic case, and reviews prevention steps like sponge counts, radiopaque markers, barcode systems, and surgical timeouts. The key message: persistent non‑healing wounds often need a detective approach to look beneath the surface.

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    July 31 · 20 min

    Forgotten Infection Friday- Melioidosis: The Soil-Borne Killer That Mimics Diabetic Foot Ulcers

    Melioidosis is an infection caused by the soil and water bacterium Burkholderia pseudomallei that can enter through cuts, wounds, or inhalation. It often mimics common conditions—pneumonia, tuberculosis, routine wound infections, or chronic diabetic foot infections—making diagnosis challenging. People with diabetes are at higher risk, and proper diagnosis requires culture and targeted therapy (IV intensive antibiotics such as ceftazidime or meropenem followed by prolonged oral eradication therapy). Prevention focuses on reducing soil and water exposure, protective footwear, wound care, and detailed environmental history for at-risk patients.

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