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Diabetic Wound Care
What is a Diabetic Foot Ulcer?
A diabetic foot ulcer is an open sore or wound
that most commonly occurs on the bottom of the foot in approximately
15 percent of patients with diabetes. Of those who develop a foot
ulcer, six percent will be hospitalized due to infection or other
ulcer-related complication.
Diabetes is the leading cause
of nontraumatic lower extremity amputations in the United States ,
and approximately 14 to 24 percent of patients with diabetes who
develop a foot ulcer have an amputation. Research, however, has
shown that the development of a foot ulcer is preventable.
Who Can Get a Diabetic Foot Ulcer?
Anyone who has diabetes can develop a foot
ulcer. Native Americans, African Americans, Hispanics and older men
are more likely to develop ulcers. People who use insulin are at a
higher risk of developing a foot ulcer, as are patients with
diabetes-related kidney, eye, and heart disease. Being overweight
and using alcohol and tobacco also play a role in the development of
foot ulcers.
How do Diabetic Foot Ulcers Form?
Ulcers form due to a combination of factors,
such as lack of feeling in the foot, poor circulation,
foot deformities, irritation (such as friction or pressure), and
trauma, as well as duration of diabetes. Patients who have diabetes
for many years can develop neuropathy, a reduced or complete lack of
feeling in the feet due to nerve damage caused by elevated blood
glucose levels over time. The nerve damage often can occur without
pain and one may not even be aware of the problem. Your podiatric
physician can test feet for neuropathy with a simple and painless
tool called a monofilament.
Vascular disease can complicate a foot ulcer,
reducing the body's ability to heal and increasing the risk for an
infection. Elevations in blood glucose can reduce the body's
ability to fight off a potential infection and also retard healing.
What is the Value of Treating a Diabetic Foot
Ulcer?
Once an ulcer is noticed, seek podiatric
medical care immediately. Foot ulcers in patients with diabetes
should be treated for several reasons such as, reducing the risk of
infection and amputation, improving function and quality of life,
and reducing health care costs.
How Should a Diabetic Foot Ulcer be Treated?
The primary goal in the treatment of foot
ulcers is to obtain healing as soon as possible. The faster the
healing, the less chance for an infection.
There are several key factors in the appropriate
treatment of a diabetic foot ulcer:
- Prevention of infection.
- Taking the pressure off the area, called
“off-loading.”
- Removing dead skin and tissue, called “debridement.”
- Applying medication or dressings to the
ulcer.
- Managing blood glucose and other health
problems.
Not all ulcers are infected; however if your
podiatric physician diagnoses an infection, a treatment program of
antibiotics, wound care, and possibly hospitalization will be
necessary.
There are several important factors to keep an
ulcer from becoming infected:
- Keep blood glucose levels under tight
control.
- Keep the ulcer clean and bandaged.
- Cleanse the wound daily, using a wound
dressing or bandage.
- Do not walk barefoot.
For optimum healing, ulcers, especially those on
the bottom of the foot, must be “off-loaded.” Patients 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 ulcer area 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,
peroxide, whirlpools and soaking are not recommended, as this could
lead to further complications.
Appropriate wound management includes the use of
dressings and topically-applied medications. These range from normal
saline to advanced products, such as 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 podiatrist can determine
circulation levels with noninvasive tests.
Controlling Blood Glucose
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
accomplish this will enhance healing and reduce the risk of
complications.
Surgical Options
A majority of noninfected foot ulcers are
treated without surgery; however, when this 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 Factors
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.
How Can a Foot Ulcer be Prevented?
The best way to treat a diabetic foot ulcer is
to prevent its development in the first place. Recommended
guidelines include seeing a podiatrist on a regular basis. He or
she can determine if you are at high risk for developing a foot
ulcer and implement strategies for prevention.
You are at high risk if you:
- have neuropathy,
- have poor circulation,
- have a foot deformity (i.e. bunion, hammer
toe),
- wear inappropriate shoes,
- have uncontrolled blood sugar.
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