Developing a Grapefruit Model for Assessment and Training of Diabetic Foot Ulcer Debridement

Introduction: Sharp debridement is the criterion standard treatment for diabetic foot ulcers (DFUs) and is performed by podiatrists in the United Kingdom. This study aimed to create a DFU model that could be used as a learning tool for trainees. Methods: In a pilot study, a penny-sized circle was drawn onto an orange to simulate a DFU. This was then critiqued by podiatrists, and the feedback received was used to create a grapefruit model with irregular shape. All podiatrists supported the switch to a grapefruit model due to improved contrast between skin and fruit. This grapefruit model was then reassessed by 50 podiatrists from the North West of England. Two freely available computer programs were assessed to measure the area debrided, and a depth scale was used to determine the depth debrided. A questionnaire was completed by the podiatrists as to the utility of the model. Results: A DFU was successfully simulated using a grapefruit and plastic template. After debridement, debrided area and depth were calculated using Image J and a depth score. Podiatrists rated this model for its utility as a training tool on a continuous rating scale with an average score of 61.9%. Conclusions: This model has potential for development as it is inexpensive and easily accessible. This model's fidelity could be bolstered by using more accurate techniques for area and depth measurement. More research is needed to determine the superiority or inferiority of this model to previous simulated DFU models.