DIABETIC ULCERS AND DIABETIC FOOT

Diabetic Foot Ulcer Treatment

A diabetic foot ulcer is the complication of diabetes mellitus occurring as a result of tissue breakdown and exposure of the layers underneath, in other words, formation of a sore. Diabetic foot ulcers generally manifest under the toes and the balls of the feet. The predominant cause of diabetic ulcers and diabetic foot are poorly controlled Diabetes and high blood sugar levels. 15 to 20% of the patients during their lifetime encounter diabetic foot ulcers leading to the risk of amputation.

Diabetic Foot Ulcer Causes

• Result of nerve and blood vessel complications
• Damage to nerve causes loss of feeling the leg or the foot (this condition is called peripheral neuropathy)
• Cuts, bruises, pressure from the shoes, and injury that is not noticed
• Patient does not receive warnings due to loss of protective sensation
• Vascular disease
  • Affects small blood vessels
  • They feed into the skin (called microangiopathy)
  • Arteries remain unaffected but are narrowed so no pulse may be felt (ischemia)
  • Ulceration due to lack of healthy blood flow
  • Impaired healing of wound
  • Aggravated by smoking

Diabetic Foot Ulcer signs, symptoms and diagnosis

• Foot ulcer signs are not very obvious
• Sometimes signs are seen only after the ulcer has been infected
• Skin discolourations are noticed

Early symptoms :

• First signs – drainage from the foot (staining socks and leaking out from the shoes)
• Unusual swelling, irritation and redness
• Odours from the feet

Serious foot ulcers :

• Black tissue called eschar surrounds the ulcer
• Formation due to absence of healthy blood flow
• Partial or complete gangrene
• Tissue death due to infections
• Odorous discharge
• Pain
• Numbness

Risk factors of diabetic foot ulcers

• Poor hygiene – no regular washing
• Poor quality shoes
• Poorly fitted shoes
• Non-trimming of toe nails
• Consumption of alcohol
• Eye disease due to diabetes
• Kidney disease
• Heart disease
• Obesity
• Use of tobacco
• Common in older men

Diagnosis

• Seriousness of the ulcer is gauged on a scale of 0 to 3
• 0: foot at risk with no ulcer present
• 1: no infection but ulcer exists
• 2: deep ulcer, exposes tendons and joints
• 3: abscesses due to infection (extensive ulcer)

Treatment of diabetic foot ulcers at Jacob’s Hospital, Kochi

• Serious complications of foot ulcers have to be addressed immediately
• Diabetic foot ulcers may require debridement
• Removal of dead skin, foreign objects or infected tissue needs to be done
• The following are recommended at the hospital
  • Off-loading or staying off the feet
  • Avoid pressure from walking
  • Wearing protective items :
    • Casts
    • Braces
    • Diabetic shoes
    • Shoe inserts to prevent corns and calluses

Counseling on foot infection prevention are advised such as :

• Disinfecting skin around the ulcer
• Foot baths
• Keeping the ulcer dry
• Change dressings frequently
• Enzyme treatments
• Calcium alginates dressings to inhibit bacterial growth

Medications prescribed :

• Antibiotics
• Anitplatelets
• Anti-clotting medications
• Anti pressure treatments
• Topical treatments such as :
  • PHMB or poly hexamethylene biguanide gel / solution
  • Silver sulphadiazine cream
  • Medical grade honey gel / ointment

Surgeries are performed :

• To debride tissue
• To amputate dead or infected bones or limbs
• To close ulcers with flaps or grafts
• Removing foot deformities such as hammertoes and bunions

Jacob’s Hospital, Ernakulam provides Diabetic Foot Care and holistic treatment with a multi-disciplinary approach for all their patients