The high incidence of foot ulceration in diabetics and potentially devastating consequences are well known in the medical community. Diabetic patients frequently develop peripheral neuropathy, a condition which causes decreased sensation in the foot. The decreased sensitivity of the foot can cause a patient to not feel something as seemingly innocent as a shoe which is too tight and rubbing an area. Diabetic foot ulcerations usually occur in areas of high pressure when we walk, commonly due to abnormal structure of the foot such as a hammertoe or bunion deformity. Many diabetics also suffer from poor circulation to their feet, which makes wound healing difficult or sometimes impossible. When wounds become chronic, patients are at increased risk for infection. Infection is more difficult to treat in diabetic patients due to the fact that their bodies immune system is not as effective at fighting off bacteria. The antibiotics that are typically used to fight infection are also not as effective if blood flow to the area is poor. This unfortunately leads to amputation for some patients with chronic diabetic foot ulcers.
The first goal of the podiatrist is the prevention of diabetic foot ulcers. Patient education and regular examination of the feet by a health care professional are critical factors in the prevention of diabetic ulcers. Strict control of blood glucose levels along with maintaining a healthy diet and exercise are essential to avoiding complications from diabetes. Your health care professional may recommend testing of the nerves and blood flow of the legs and feet to check for signs of neuropathy or poor circulation. This can give valuable information and depending on the findings of these tests, treatment recommendations can be made to prevent these conditions from worsening. Diabetic patients should see their podiatrist regularly for care of their nails and feet. Areas of the foot that develop callus tissue should be shaved down to reduce the chance of skin breakdown leading to ulcer formation. Diabetic custom made shoes have been shown to decrease the incidence of ulceration of the diabetic foot. The shoes are constructed with extra depth to accommodate a cushioning insole to reduce pressure points on the bottom of the foot. Diabetic patients should inspect their feet on a daily basis. As diabetics are susceptible to extremely dry skin, a good moisturizing cream should be applied daily to reduce the chance of skin cracks. The areas around the toes should be dried thoroughly after showers or baths and a drying agent such as desenex powder may be applied to reduce the risk of developing fungal infections. Any breaks in the skin, redness, swelling or pain should prompt an immediate visit to the podiatrist. A seemingly small situation can rapidly develop in to a big problem for diabetic patients.
The initial traditional treatment of diabetic foot ulcers is aimed at reducing the risk of infection and stimulating the bodies healing process. The most important part of the treatment is regular debridement of the ulcer. This involves the removal of all dead or callused tissue around the edges or at the base of the wound by your health care professional. This procedure helps to reduce the risk of infection and can help accelerate the healing of wounds. It is important to remain off the affected foot as much as possible. Your podiatrist can make recommendations to decrease pressure on the ulcerated, which will also help speed the healing process. This could entail padding of the affected area along with the use of surgical shoe or boot to offload the ulcer site. If there is the suspicion of infection, a wound culture can be performed and appropriate antibiotics may be prescribed. There are currently a myriad of topical wound care products that may be prescribed to help decrease the chance of infection and facilitate the healing of diabetic foot ulcers. When these traditional wound care techniques are ineffective, other treatment options should be considered.
A new option for the treatment of chronic diabetic ulcers is offering hope for many patients with chronic non-healing wounds. This involves the use of allograft tissue, a graft obtained from an unrelated human donor. The graft is obtained from the innermost layer of the human placenta and lining of the amniotic cavity of a newborn. Potential donor mothers are screened and tested for infectious diseases and the graft is sterilized prior to implantation. This tissue is chosen because it enhances healing of wounds by delivering a high concentration of the bodies naturally occurring growth factors needed for wound healing. The tissue used in the graft has been shown to decrease inflammation and scarring to the involved region. The reduction of inflammation and scarring has been shown to help facilitate healing of chronic wounds. Preliminary studies show the graft has led to increased likelihood of healing of chronic wounds and faster wound healing times. The graft can frequently be applied in the office setting and is a painless procedure that does not require anesthesia.
While techniques and technologies have improved in recent years, prevention still remains the most effective tool in the treatment of diabetic foot ulcers.
If you or a loved one is suffering from diabetic foot ulcers the doctors and staff at Atlantic Foot & Ankle Specialists are ready to help. http://www.atlanticfeet.com
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