Efficacy and Safety of a Nitric Oxide Generating Dressing for Diabetic Foot Ulcers (ONWARD)

Inclusion Criteria: IC-1 - Subjects at least 18 years old and willing to participate in all procedures and follow-up evaluations necessary to complete the study IC-2 - The subject must have either type 1 or type 2 diabetes and a diabetes-related ulcer meeting all the following characteristics: IC-2a Classified as University of Texas (UT) Classification Grade 1 stages A-D IC-2b At or below the level of malleolus IC-2c Neuropathic or neuroischemic etiology confirmed through Electronic Medical Records (EMR) IC-2d Ulcer surface area between ≥1 and ≤25 cm² IC-2e For subjects who have more than one ulcer, the largest ulcer will be the study ulcer IC-3 Non-infected and infected ulcers are eligible for inclusion, with infection being classified using the International Working Group on the Diabetic Foot (IWGDF) Infection guidelines. Only PEDIS 2 infections are permitted. Mild superficial skin and soft tissue infections with no systemic manifestations, characterized by erythema \>0.5 but \<2 cm from the wound margin and/or other local signs of infection (swelling, induration, tenderness, increased warmth, or purulent discharge), without involvement of deeper tissues (e.g., tendon, muscle, joint, or bone). IC-4 Adequate arterial supply in the lower extremity as defined by Wound, Ischemia, foot Infection (WIfI) Ischemia grade 0-1; 1. Palpable foot pulse with biphasic or triphasic pedal Doppler waveforms, AND 2. Ankle Brachial Index (ABI) \>0.6 OR Toe Brachial Index (TBI) \>0.5, OR 3. Toe pressure \>40mmHg Exclusion Criteria: EC-1 Ulcers that are tunnelling or have cavities (\>10mm in depth) EC-2 An ulcer that is actively bleeding. Subjects may be re-screened once active bleeding has stopped EC-3 Subjects taking any medication known to inhibit wound closure including chemotherapy and immunomodulatory biological agents. The use of systemic corticosteroids \<10mg/day is permitted EC-4 Active Charcot foot