Diabetic Foot Ulcers : Prevent them, treat them right

Diabetic Foot Ulcers : Prevent them, treat them right

Diabetic? Here’s why (and how) you have to take extra special care of your feet.

A skin ulcer occurs when an area of skin has broken down and the underlying tissue can be seen. Most skin ulcers occur on the lower legs or the feet. In a normal person, the skin ulcer heals quickly after the injury. However, in a person with diabetes, the healing process is impaired and takes more time even if the injury is minor.

An ulcer can develop from any source of irritation to the skin: a corn or callus that grows too thick, excessive pressure or abrasion of one part of the foot, or a splinter or other type of trauma that injures the surface of the foot. If you have neuropathy, you may not even notice that you have hurt yourself or that your skin is irritated, because you can’t feel the pain. But the wound could still be doing you harm, even if it doesn’t hurt. If you continue to walk on your injured foot, you can make the ulcer worse. It may be slow to heal and is likely to become infected. An infection can be even harder to cure and may eventually penetrate the bone, a condition that could require amputation. Therefore it is important to seek the correct treatment for foot ulcers and at the same time prevent them.

About 1 in 6 people with diabetes develop a foot ulcer at some stage. Such foot ulcers do not heal easily, are difficult to treat, and are more prone to serious infection.

If you notice any open sore, bleeding, or irritation, no matter how small, you may have an ulcer or be at risk for developing one. Even if you don’t have visible ulcer, any sort of callus, corn, or area of redness requires prompt attention. If there is any redness, swelling, warmth, or drainage around the ulcer, you may have an infection.

Untreated ulcers put you at great risk for infection and foot amputation. The risk is greatest among people with diabetes who maintain poor blood glucose control and among those who smoke. Among people with diabetes, 90 percent of all foot amputations occur in people who smoke. There is also an increased risk of developing an ulcer if you have signs of neuropathy or compromised blood supply to the foot.

If you notice any sort of cut, abrasion, or opening on your foot, call your physician/foot care surgeon(podiatrist) right away. The sooner you begin treatment, the greater you decrease the risk of infection. Do not put off seeking treatment because it doesn’t hurt or the sore is not too big. In the meantime, if you have any ulceration, do not walk on your injured foot and do not exert any pressure on the ulcer. This will only make it worse and increase the risk of infection.

Your doctor will evaluate the depth and size of the ulcer. Your foot will also be X-rayed to determine whether there is any foreign matter in your foot, whether there are signs of infection in the bone, and whether there is any gas or air deep in the wound. Gas or air in a wound is a sign of infection. Your doctor may also choose to biopsy your ulceration, especially if it is in an unusual place. Most foot ulcers develop on the toes or the ball of the foot.

Your doctor will probably remove or debride any dead tissue present in your ulcer. Dead tissue makes it more difficult to heal and increases the changes of infection. Your doctor will also send material from the ulcer to make sure there are no bacteria or other microorganisms present, which indicate infection.

 

A foot ulcer can take months to heal. It is important during this period to keep your blood glucose levels under control and to stay off your foot. Peripheral vascular disease can impair the healing of a foot ulcer. If you have significant blockages that are preventing blood flow to your legs, your doctor may suggest bypass surgery.

Over the last 10 to 15 years, a large number of trials have been performed to evaluate the safety and efficacy of growth factors in the healing of chronic wounds due to pressure (decubitus ulcers), diabetic neuropathy, and venous insufficiency. The greatest potential for the use of growth factors in chronic wound care is that they can accelerate healing. Growth factors work by binding to specific cell surface receptors and can target cells in a number of recognized ways or modes. After binding to receptors, growth factors can have a profound influence on cell proliferation, chemotactic activity, and extracellular matrix synthesis.

Epidermal growth factor (EGF) belongs to a family of growth factors that regulate cell proliferation, migration, and differentiation through binding to receptor kinases on target cells. Epidermal growth factor has been shown to act as a mitogen and also a differentiation factor for many cell types. Today these Epidermal growth factors are available as gels which can be applied to the wound topically during dressing to help them heal faster.

 

Research has shown that these growth factors significantly accelerate diabetic foot ulcer wound healing and reduces the healing time. However they are expensive at present since they are made by recombinant biotechnology. Further they have to be preserved between 2 and 8 degree centigrade to protect their efficacy. Trials so far have not revealed any adverse effect from the use of topical growth factors at present.

 

PREVENT ULCERS !

You can take several steps to minimize the risk of developing foot ulcers and infections. Make sure to visit a foot specialist on a regular basis. You need to see a podiatrist who is trained in the care of the diabetic foot. Your podiatrist should examine your feet and check for signs of neuropathy, circulatory problems, and any potential trouble spots. Your podiatrist will also trim your toenails and calluses before they become a problem.

 

Your podiatrist should also determine whether you need any special therapeutic footwear or any orthotic devices to keep your feet well protected. You may find that a good pair of athletic shoes works just fine but check with your Podiatrist first. Your podiatrist will also determine whether you need any special accommodations to reduce pressure points in your feet. You may need extra padding, insoles, orthotics, or special therapeutic shoes. Your podiatrist will also evaluate whether you need any sort of prophylactic surgery to correct any existing or developing foot deformities.

 

In addition to regular visits to your doctor and podiatrist, there are several steps you can take to prevent ulcers from developing or bleeding, abrasion, ulceration, or lesions on the bottom of the feet and between toes. Use a mirror to see the bottom of your feet and toes. Ask a family member to help if necessary to ensure a thorough inspection.

 

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