Chronic diabetic foot ulcer is a major cause of amputation in the world today. Globally such ulcers occur in 25% of all the patients with diabetes and in developing nations the percentage is likely to be higher [1]. Every 20 s a diabetic patient loses a leg due to inadequate foot management. It is estimated that a significant proportion, i.e., more than 85% of amputations are preventable by using appropriate wound care therapeutics [2].
In India, more than 60 million people are affected by diabetes mellitus (Majra and Acharya, 2009) and ulcers affect a huge population among them, which is big burden contributing to the socioeconomic impact for the country. Increased efforts to strengthen wound care management will lead to significant reductions in diabetic ulcer related disability and economic impact.
Diabetic neuropathy and peripheral vascular disease are 2 major factors causing diabetic foot ulcers (DFUs).
People with advanced diabetes have a diminished perception of pain in the extremities due to nerve damage, and therefore may not initially notice small scratches or bruises on their legs and feet
The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible.
There are several key factors in the appropriate treatment of a diabetic foot ulcer:
Not all ulcers are infected; however, if your wound care physician diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.
To keep an ulcer from becoming infected, it is important to:
For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.” You may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the area with the ulcer and help to speed the healing process.
The science of wound care has advanced significantly over the past ten years. The old thought of “let the air get at it” is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full-strength betadine, hydrogen peroxide, whirlpools, and soaking are not recommended, as these practices could lead to further complications.
Appropriate wound management includes the use of dressings and topically-applied medications. Products range from normal saline to growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.
For a wound to heal there must be adequate circulation to the ulcerated area. Your wound care specialist can determine circulation levels with non-invasive tests.
Tightly controlling blood glucose is of the utmost importance during the treatment of a diabetic foot ulcer. Working closely with a medical doctor or endocrinologist to control blood glucose will enhance healing and reduce the risk of complications.
A majority of non-infected foot ulcers are treated without surgery; however, if this treatment method fails, surgical management may be appropriate. Examples of surgical care to remove pressure on the affected area include shaving or excision of bone(s) and the correction of various deformities, such as hammertoes, bunions, or bony “bumps.”
Healing time depends on a variety of factors, such as wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and what is being applied to the wound. Healing may occur within weeks or require several months.
Good diabetes management and regular foot care help prevent severe foot sores that are difficult to treat and may require amputation.
The good news is that proper diabetes management and careful foot care can help prevent foot ulcers. In fact, better diabetes care is probably why the rates of lower limb amputations have gone down by more than 50 percent in the past 20 years.
When foot ulcers do develop, it’s important to get prompt care. More than 80 percent of amputations begin with foot ulcers. A nonhealing ulcer that causes severe damage to tissues and bone may require surgical removal (amputation) of a toe, foot or part of a leg.
Some people with diabetes are more at risk than others. Factors that lead to an increased risk of an amputation include:
Here’s what you need to know to keep your feet healthy, the signs you need to see a doctor and what happens if amputation is necessary.
The best strategy for preventing complications of diabetes — including foot ulcers — is proper diabetes management with a healthy diet, regular exercise, blood sugar monitoring and adherence to a prescribed medication regimen.
Proper foot care will help prevent problems with your feet and ensure prompt medical care when problems occur. Tips for proper foot care include the following:
Sprinkle talcum powder or cornstarch between your toes to keep the skin dry. Use a moisturizing cream or lotion on the tops and bottoms of your feet to keep the skin soft. Preventing cracks in dry skin helps keep bacteria from getting in.
If one foot is bigger than the other, buy shoes in the larger size. Your doctor may recommend specially designed shoes (orthopedic shoes) that fit the exact shape of your feet, cushion your feet and evenly distribute weight on your feet.
Contact your doctor if you have:
Your doctor will inspect your foot to make a diagnosis and prescribe the appropriate course of treatment.
