Overview
A diabetic foot ulcer is an open sore that appears on the skin. It is a common complication of diabetes and mainly occurs due to nerve damage or poor blood flow in the surrounding areas.
People who are suffering from diabetes-related conditions like heart disease, kidney problems, or are obese are at higher risk of developing diabetic foot ulcers.
Diabetic foot ulcer treatment should not be delayed. Proper and on-time treatment will ensure faster recovery and complete healing of diabetic foot ulcers. Unhealed or infected ulcers may lead to gangrene and even need an amputation.
Why do diabetic foot ulcers heal slowly?
Certain factors influence the healing of diabetic foot ulcers:
High blood glucose levels
High blood sugar can lead to complications of poor blood supply, nerve damage, and slow wound healing
Poor circulation
High glucose thickens the blood and makes it harder for the heart to pump blood from the heart to the rest of the body.
Diabetes can lead to weakened veins. Plaque buildup can narrow down the arteries resulting in poor blood flow. It is harder for the blood to reach the wound site and fight the infections.
Weak immune system
Diabetes weakens the immune system and reduces the body’s ability to protect itself from infections.
Diabetic neuropathy
Prolonged diabetes can lead to a condition called diabetic neuropathy where there is a loss of sensation in the nerves. If left untreated, it can seriously impact wound healing.
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Can diabetic foot ulcers recur?
Research studies have shown that around 40% of people who had diabetic foot ulcers have reported recurrence within the first year of healing and about 65% in the next 5 years.
People with diabetic foot ulcers along with peripheral neuropathy have diminished sensation which puts them at risk of unnoticed trauma and injury in the affected area. The ulcerated skin becomes weak and becomes prone to recurrent diabetic foot ulcers.
After healing, many people neglect proper follow-up foot care and take preventive measures which can lead to recurrence.
What is the treatment for diabetic foot ulcers?
Treatment for diabetic foot ulcers depends on the size, depth, stage, location, and presence or absence of infections.
The best treatment for diabetic foot ulcers includes nonsurgical as well as surgical treatments.
Nonsurgical treatment for diabetic foot ulcers includes:
Off-loading pressure
The doctor will ask you to put less pressure on the ulcer as the ulcer can expand and get infected. Using casts, specialized shoes, compression wraps, or foot braces can help.
Doctors may recommend orthotics or shoe inserts that are soft, foam, or gel-like inserts that support the foot while walking and distribute the weight when you walk. A donut-shaped padding can be recommended. These paddings are inserted into the shoes to relieve pressure and allow the ulcer to heal.
Medication
Oral antibiotics are prescribed to fight the infection. The length of the medication depends on the extent of the infection.
Ulcer dressings
There are different types of dressings to protect the wound site from bacterial growth and promote healing.
Procedures
Debridement is a procedure where the doctor removes dead and unhealthy tissues to promote wound healing. A sharp tool or a scalpel is taken to scrape off the tissues in and around the ulcer. The wound is then cleaned with a disinfectant solution and covered with a sterile bandage.
After the procedure, the wound should be cleaned daily and covered with a new dressing. An ointment may be prescribed to be applied to the wound site. The doctor may prescribe over-the-counter medications for pain relief.
This procedure prevents the ulcer from getting bigger and protects it from infections.
Vascular surgery
Sometimes diabetic foot ulcers are caused by lower extremity arterial diseases which can result in poor blood flow and diminished wound healing. The doctor may perform a vascular surgery to clear the clogged artery.
Amputation
An amputation is recommended if there is severe gangrene which can be life-threatening to the patient. Amputation can be minor or major depending on the severity of the disease.
Minor amputation refers to limited necrotic tissue excision, generally done at the ankle or below.
Major amputation can be considered after a minor amputation when the gangrene has spread to the mid-foot area and if there is a loss of mobility. Major amputation includes below or above-knee amputation.
