According to the American Academy of Family Physicians, ulcerations seen on the foot of any diabetic patient may constitute the most common etiological factor for amputation of the lower leg. Diabetes is a metabolic disorder that has a negative effect on several systems of the body. One of the many problems caused by diabetes includes curtailment of proper circulation of blood throughout the body (particularly the legs and feet).
This change along with damage caused to the nerves (diabetic neuropathy) form the two crucial factors that increase the susceptibility of the diabetic individual towards development of foot problems, mainly foot ulcerations and varying degrees of infection. There exist several non-surgical and surgical approaches for the treatment of diabetic ulcers. Let’s take a look at these treatment options.
List of Effective Treatment Options for Diabetic Ulcer
Offloading of the Wound
To ensure that the patient stays off the affected diabetic foot (known as offloading), he or she requires to make an appropriate selection of footwear. Extra depth, also known as diabetic or therapeutic shoes must be used so as to minimize further risk of skin rupture and injury. Another alternative for offloading is to make use of either a pair of crutches or a wheelchair.
Although time consuming for application, minimally padded, total contact cast or TCC can be used to alleviate the pressure on the ulcerated plantar surface and to redistribute it along the wall of the cast worn and the rear foot region. The reduced concentration of pressure over the affected area automatically facilitates quicker wound healing.
Closely Monitor Your Feet for Changes
Yes, you must take note of that. Closely inspect your feet on a daily basis for physical changes, such as the formation of cracks, inflammation, blisters and feelings of numbness or tingling. You must immediately inform your physician about such changes so that the appropriate treatment can be started without any delay.
Thorough Debridement Is Needed
In many cases, doctors need to perform the surgical procedure of debridement so as to remove the necrotic tissue or calloused skin.
The aim is to continue careful removal of the infected or dead tissue till the point a healthy edge has been brought to the surface. Also, debridement allows the wound to contract and heal properly. In certain cases, this process is repeated multiple times so as to achieve adequate healing. Local anesthetics may need to given in order to reduce post-operative pain.
Dressing or Coverage of the Wound
Once debridement is done, a dressing consisting of sodium chloride (in moist, gel or paste form) is applied over the surgically debrided foot. Damp or wet dressings ensure thorough coverage of the wound as the constituent absorbs the exudate and offers protection to the surrounding vital tissue. For less exudative wounds, polyvinyl dressing is considered so that oxygen and moisture may have access to the wound without allowing any bacterial invasion.
The dressing may need to be changed more than once in a day, especially in cases where the wound is highly exudative in nature. The type of dressing used may vary in accordance with the nature of the injury and its location.
Antibiotics for Treating Diabetic Foot Ulcer
Antibiotics are considered as a helpful line of treatment in healing foot ulcerations and infection. Diabetic patients with a mild degree of ulceration on the foot are often given oral antibiotics, such as Cephalexin or Clindamycin for fighting microbial growth and infection (mainly caused by Staphylococcus aureus or Streptococcus).
Severe cases often require hospitalization and intravenous administration of antibiotics, like Ampicillin or Piperacillin. Once prescribed, the patient must take the entire antibiotic course (usually lasts for four to six weeks) for thorough resolution of the infection followed by healing.
Medicine For Wound Healing
In an attempt to promote appropriate healing of the foot, doctors may recommend the topical use of platelet derived growth factors; for example Becamplermin in gel form (marketed as Regranex). The role of Regranex gel is stimulation of the migration as well as proliferation of cells that aid in healing of neuropathic, diabetic ulcers.
Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy is not used commonly and must not be considered as the perfect substitute for revascularization. Using this form of therapy, oxygen is supplied to the ulcerated areas so as to reduce the extent of swelling and quicken the process of healing. As 100 percent of oxygen reaches the area, circulation of blood enhances, which in turn, favours the formation of new vessels as well as healthy tissue. You must, however, note that this treatment proves beneficial only in selected cases.
The use of skin grafts may be considered in diabetic foot ulcers that fail to show improvement with other forms of treatments. By performing this surgical procedure, the rate at which the wound heal is hastened, and health skin growth takes place. The other advanced treatment available is known as negative pressure wound therapy (NPWT) which increases the success rate of skin grafting procedure to quite an extent.
Lifestyle and Dietary Changes
For those living with diabetes, apt foot care becomes an important component of preventing and treating diabetic ulcers. To ensure the same, one needs to quit the habit of smoking any form of tobacco as this injurious habit not only favours poor circulation of blood, but also induces harmful changes in the blood carrying vessels which increase the chances of foot infections and slows the rate of healing, as well.
The second pivotal guideline for treating and controlling foot problems in diabetes is following a healthy diet plan. Modify your dietary schedule so that the level of blood sugar stays well within the normal range. Also, the patient must get his or her blood sugar checked at frequent intervals and maintain a record of it. Other than that, it is essential to indulge in physical activity on a regular basis. Doing so improves the blood circulation to the legs, feet and aids in maintaining normal blood sugar level. Always consult your doctor for which type of exercises to perform.