Foot Ulcer Treatment
How to Treat Foot Ulcer?
Foot ulcer is a major problem that is characterized by the formation of open wounds on the foot. This condition is commonly seen in diabetic patients, which unfortunately in majority of the cases leads to lower extremity amputations. Foot ulcers are usually caused by factors such as trauma to the feet, peripheral neuropathy (a condition caused by diabetes in which the peripheral nerves are damaged leading to the malfunctioning of the motor, sensory and autonomic nerves) and peripheral vascular disease (a condition where the blood vessels to the lower parts of the body become narrow, leading to decreased blood supply to those areas). Foot ulcers if left untreated can cause the development of debilitating infections which may ultimately lead to lower-limb amputations. Therefore, if you notice any of the associated signs or symptoms, it is important to get immediate foot ulcer treatment in order to facilitate healing and prevent further complications.
Foot ulcer treatment begins with a prompt evaluation of the condition. You should inform your doctor about any surgical procedures you have undergone in the past, medications, and any other medical conditions you may have. The doctor may also conduct a physical exam and perform tests. All these factors would help the doctor to arrive at an accurate diagnosis of your ulcer. The first step in the treatment involves thorough cleansing and dressing of the wound for obtaining wound closure. After a few weeks, there should be significant improvement in the wound bed.
If there is no noteworthy improvement in the condition after the first few weeks of wound care, the patient may have to undergo advanced therapies. Advanced foot ulcer treatment involves the use of several wound- healing techniques, some of which are listed below.
- Debridement – Surgical or sharp debridement is carried out by removing the dead and infected tissues from the wound bed by using surgical instruments such as scissors, curettes and scalpels. After the procedure, moist wound care dressings may be used.
- Debriding agents – This method uses enzymatic debriding agents that dissolves the dead tissues in the wound and facilitate healing. These are available in the form of ointments that can be applied once a day. Although they are very effective in removing the dead and infected tissues, they are not as fast as the surgical debridement process. In some cases, combination of the two treatment methods may be used.
- Pulse lavage therapy- This procedure uses a water-gun–like apparatus attached with a suction device to clean and debride the wound simultaneously.
- Hyperbaric oxygen therapy – In this procedure, the patient is made to lie in an acrylic tube filled with 100% oxygen under twice or thrice the normal atmospheric pressure. This treatment method helps to increase the oxygen level in the blood and also the oxygen supply to the tissues. This procedure that lasts for about 1.5 to 2 hours is to be done daily and requires an average of 20 to 30 sessions.
- Growth factor therapy – This therapy makes use of engineered human growth factors to promote healing. A topical gel that contains recombinant human platelet-derived growth factor (rhPDGF) is often used for foot ulcer treatment. The gel has to be applied daily with weekly monitoring of the progress of the condition. Becaplermin (Regranex gel) and granulocyte colony-stimulating factor (G-CSF) are other examples of growth factors.
- Soft tissue coverage of the wounds – In this foot ulcer treatment method, skin graft taken from the patient’s own skin or bioengineered tissues are used to cover the wounds.
- Energy therapies – This technique involves passing of energy into the wound to initiate the healing process. Energy therapies have to be performed at least three times a week for about 3 or 4 weeks or until the wound begins to heal. The various methods of energy therapies commonly used involve
- Passing of high-voltage pulsed electrical energy into the wound (electrical stimulation)
- Passing of high-energy acoustic waves into the wound (ultrasound)
- Using an ultrasound-created mist (MIST Therapy System)
- VAC therapy (Vacuum-assisted closure therapy) – VAC therapy uses negative-pressure therapy in which a polyurethane sponge attached to a plastic tube is applied on the wound bed. The plastic tube is attached to a pump that produces negative suction which helps to drain the wound. This is a portable device and can be attached to the waist belt.
Once the foot ulcer has been treated and the wound healed, it is important to take precautionary measures to prevent its recurrence. People with a history of prior diabetic foot ulcers are at a high risk for developing subsequent ulcers. Appropriate foot care, inspection of the foot on a regular basis and proper management of even minor wounds can help to prevent foot ulcers to a great extent. If foot ulcers develop despite following these preventive measures, immediate medical care should be sought for and foot ulcer treatment should be started promptly.