What if I do get a diabetic foot ulcer?
It is estimated that about 15% of people with diabetes will develop a foot ulcer sometime during their lifetime. Fortunately, up to 86% of foot ulcers will heal when treated properly. A foot ulcer is defined as a break in the skin or deep sore; they are most often located on the ball of the foot, an area of repeated stress.
If you develop any kind of sore or wound on your feet that doesn't heal in a day or two, it's very important that you see your doctor or foot care specialist right away. Untreated lesions or ulcers can become infected quickly; even when treated, foot ulcers may not heal well in people with diabetes.
How are diabetic foot ulce
Your doctor may x-ray your feet to make sure the bone is not involved. If the results are not clear, you may have an MRI scan to help your doctor determine the extent of the lesion.
Treatment must address all of the factors involved in wound healing:
· Infection - which stops or delays the normal wound repair process.
· Repeated trauma during the wound healing process - which continually destroys new tissue.
· Decreased blood flow - which reduces the amount of oxygen and nutrients getting to the tissues.
Treat the infection
The doctor will thoroughly clean the wound to remove all infected tissue; in severe cases, this may be done in the operating room. Early, aggressive wound cleaning (called "debridement") has been shown to heal these wounds more rapidly. If there is an infection, your doctor will prescribe antibiotics. If the infection is serious, you may be hospitalized to receive intravenous antibiotics.
Dressings are used to prevent further trauma, to minimize the risk of infection, to relieve local pain, and to optimize the environment for healing. A moist wound environment is important for wound healing to occur.
You can help by keeping the area clean and moist at all times and using the medications your doctor has prescribed for you. It's important that you only use the medications your doctor has suggested. People used to use cleansers or antiseptics such as hydrogen peroxide on these types of wounds, but it is now known that they actually delay wound healing. They also dry out the tissue, and it is now believed that a moist environment stimulates more rapid wound healing.
Depending on the location of your foot ulcer, you may need to keep pressure off the area. This is called "off-loading" and means avoiding all mechanical stress on the wound so that it can heal. If there is no infection, a total contact cast may be used to relieve pressure. Or your doctor may recommend using "non-weight-bearing" devices such as orthopedic shoes, a walker, crutches, or even a wheelchair or bed rest - these can help healing by relieving pressure on the injured part of your foot. If your doctor has suggested keeping weight off of your foot, it's important to do so. Keep your foot elevated as much as possible.
If there is evidence of impaired blood flow to your feet, then your doctor may consider a surgical procedure called "revascularization." This involves bypassing or implanting a graft past lesions in the arteries that are obstructing blood flow. These procedures have been as successful in restoring blood flow for people with diabetes as in others and have been shown to help achieve rapid and durable healing of diabetic foot ulcers. They have also been shown to decrease the need for amputation.
New treatments such as recombinant growth factors and bioengineered skin patches are now available to help improve healing of foot ulcers. Growth factor gels contain a protein that helps the ulcer fill in with healthy tissue, so it heals faster and better than it would otherwise. Human skin cells are processed and grown in the laboratory to produce bioengineered skin, or skin equivalents, which are applied to the foot ulcer to enhance the process of wound healing. Foot care experts are encouraged by the early results of these treatments, which they say "are healing diabetic foot wounds faster and preventing amputations." Used with traditional approaches such as removing pressure, the new high-tech treatments reduce healing time, infection, hospitalization, and amputation while improving the quality of life. They've been called "a winning combination to reduce the needless number of lower extremity amputations in this country."
Other treatments are sometimes used but, according to the American Diabetes Association, they have not been adequately tested in clinical trials to prove their worth. These include hyperbaric oxygen, electrical stimulation, cold laser, and heat treatments