Diabetic Foot Ulcer Treatment
How To Treat Diabetic Foot Wounds?
Diabetic foot ulcer is an open wound that occurs in the foot of diabetic patients. Without prompt diagnosis and appropriate treatment, this condition can cause severe complications. This is because, in diabetic patients wound healing is impaired and so the wounds can become deeper and can even spread to the bones. Diabetic foot ulcer is the main reason that leads to majority of the lower extremity amputations in diabetic patients. Getting treatment at the right time helps the foot ulcer to heal completely and moreover reduces the risk of losing your foot.
The main objectives of diabetic foot ulcer treatment are obtaining complete closure of the wound or ulcer, relieving pressure on the foot, removal of infection and management of ischemia. Prior to starting treatment it is important to determine if the ulcer is neuropathic (caused by peripheral neuropathy) or ischemic (caused by peripheral arterial disease). In order to improve the outcome, this condition also requires the assessment of experts from multiple medical disciplines such as a diabetologist, orthotist, podiatrist, vascular surgeon, neurologist and a nurse.
Wound Closure
The first step in diabetic foot ulcer treatment involves thorough cleansing of the wound and preparing it to heal and ultimately enable the closure of the wound. The various steps involved in attaining this goal includes
- Debridement – This is the process by which dead or infected tissue is repeatedly removed by surgery. In some cases the dead tissue may also be removed by using chemical debriding agents such as enzymes which dissolves the dead tissue. Proper debridement is essential to reduce the risk of infection.
- Wound dressings – The wounds are dressed in such a way as to provide a favorable environment that promotes tissue repair and enables proper healing. Hydrogels, hydrocolloids, alginates and foams are some of the elements used for preparing the wound dressings.
- Soft-tissue coverage of the wounds – The diabetic foot ulcers are usually covered with skin grafts taken from the patient’s own skin (autologous skin graft), taken from a cadaver (cadaveric skin graft) or by using bioengineered skin substitutes.
- Growth factors – These are actually proteins that encourage cell division and promote healing of wounds. Becaplermin (Regranex gel) and granulocyte colony-stimulating factor (G-CSF) are examples of such growth factors.
Offloading
Offloading is the technique of relieving the pressure on diabetic foot ulcers. The various approaches to offloading include the use of special shoes, casts, braces, crutches, wheelchairs, canes and insoles. It is also important to avoid the use of ill-fitting shoes. Rest and elevation of the affected foot also helps to promote healing of diabetic foot ulcers.
Removal of infection
The possibility of amputation of the limbs increases if there is infection of the diabetic foot ulcer. The following methods are usually employed for the management of diabetic foot ulcer infections
- Culture of the wound – The infected wound is cultured and the organisms causing the infection are identified
- Debridement – surgical removal of dead or infected tissues present in the wounds
- Treatment using antibiotics – All infections of diabetic foot ulcers would require treatment with antibiotics. Mild infections would require a 7-10 day course of antibiotic treatment whereas severe cases usually require an extended course of treatment.
- Surgery –If the infection has spread deeper into the bones, surgery for resection of the infected bone has to be done. In addition to surgery, 4 to 6 weeks of parenteral antibiotic therapy will also be required.
Management of Ischemia
If the diabetic foot ulcer is caused by peripheral vascular disease or ischemia, a vascular surgeon has to be consulted for further assessment. The treatment options for this condition includes
- Hyperbaric oxygen therapy
- Vascular surgery to re-establish adequate blood flow to the affected foot
- Angioplasty and stenting
Conclusion
Patients having diabetic foot ulcers should undergo urgent treatment to reduce the risk of infection, prevent the loss of his/her limbs, avoiding longer term treatment costs and improving quality of life. Therefore if an ulcer is noticed in the foot, make sure to seek medical care immediately. After a successful diabetic foot ulcer treatment, it is important to prevent the recurrence of a subsequent ulcer. Since the risk of amputation increases with each recurrence of the ulcer, preventing recurrence is a key objective in the management of patients who have had previous incidents of diabetic foot ulcers.