Diabetic Foot Ulcer
Diabetic foot ulcers are wounds that occur at an existing or previous foot ulcer in people with diabetes. Around 15 to 25 percent of diabetes patients run the risk of developing them.
The most common locations for a diabetic foot ulcer are under the big toe and the ball of your foot. But they can also occur on the foot’s arch or heel, as well as between your toes.
The severity of a diabetic foot ulcer varies greatly depending on the location and type of wound. In general, they can cause pain as well as numbness or tingling sensations around the wound.
People with foot ulcers may also experience foot deformities that limit their mobility and the range of motion in the foot.
Diabetes can lead to serious complications if left untreated, including foot gangrene. It occurs when tissue dies due to the lack of blood supply and can lead to amputation or death.
Some factors that can cause a diabetic foot ulcer to include poorly fitted or poor quality shoes, poor hygiene (not washing regularly or thoroughly or not drying the feet well after washing), improper trimming of toenails, alcohol consumption, obesity, and tobacco use.
According to a report from United Healthcare, Diabetic foot ulcers account for about half of limb loss in diabetic patients.
Diabetic Peripheral Neuropathy
It is the leading cause of non-traumatic leg amputations. Diabetic Peripheral Neuropathy is a diabetic complication involving nerve damage in the extremities. It may present itself as foot pain, abnormal sensations (i.e., numbness or tingling), or weakness in one’s feet and legs.
Diabetic neuropathy often leads to diabetic foot ulcers (DFUs). In addition, a diabetic person with diabetic neuropathy has an increased risk of developing infections, including osteomyelitis, that may lead to diabetic foot ulcers.
These bone infections can progress rapidly into osteomyelitis within 48 hours if they are not detected early and treated promptly. The best way to detect the infection’s spread is through the appropriate medical imaging. Diagnostic imaging usually involves a foot x-ray to rule out bone infection first. The reason is that a bone infection is much harder to treat and can easily lead to septic shock or death.
Diabetic neuropathic pain affects up to 50% of diabetic patients who have had diabetes mellitus for ten years or more. In addition, patients with diabetic neuropathy have a five times greater risk of diabetic foot ulcers and a sevenfold higher risk for lower extremity amputations. Beyond bone infections, to prevent the occurrence of the musculature around the wound becoming necrotic, magnetic resonance imaging is used to get a clear picture of the tissue in and around the wound.
Some patients may only display loss of sensation to light touch. Others may exhibit one-sided weakness, cramping calf muscle pains that are worse at night, problems emptying the bladder, impotence or changes in sexual activities, or diabetic amyotrophy in the upper extremities.
Diabetic neuropathy impairs the body’s ability to fight infection, making it easier for wounds on the feet or legs of diabetic patients to become infected by various pathogens.
Granuloma Annulare
It is a skin condition in which a distinctive ring-shaped, firm lesion appears on the skin. In diabetic individuals, diabetic neuropathy can lead to small blood vessel changes that cause these granulomas annul are lesions to appear.
These lesions are usually found on lower legs and feet, resulting in diabetic foot ulcers. In addition, these lesions can also occur on the hands and arms.
Diabetic peripheral neuropathy may be diagnosed by a healthcare professional using clinical examination and special tests such as an EMG/nerve conduction study (NCS) to measure electrical signals traveling through muscles.
A high index of suspicion is necessary because diabetic neuropathy may present with only diabetic dermopathy (in mild cases), diabetic amyotrophy, mononeuropathies, or multiple mononeuropathies.
If the condition worsens, diabetic peripheral neuropathy may cause loss of sensation; numbness, painful tingling or prickling sensations; burning pain in one’s feet and legs due to nerve damage; loss of reflexes; difficulty moving one’s toes, ankles, knees, and hips or shoulders.
Diabetic peripheral neuropathy can be prevented by controlling high blood sugar levels.
Patients should check their feet daily for injuries and infections, including blisters, sores, redness, swelling, pain, tenderness, or ulcers. In addition, they should inspect their toenails for fungus and take measures to prevent fungal infections.
Identifying the Symptoms
One of the initial signs of a diabetic foot ulcer is fluid leaking from one or both feet. Other than that, some of the other early symptoms include:
- Unusual swelling
- Redness and irritation
- Increased warmth or temperature changes
- Increased pain in your foot when pressure is applied
- Odors
- Tenderness around the wound site
Some other visible signs include a black tissue called an eschar that forms due to the abnormal flow of blood to the area surrounding the ulcer.
Formation of full or partial gangrene happens when tissue dies due to infection. It causes pain, odorous discharge, as well as numbness or a tingling sensation. A diabetic foot ulcer can be potentially lethal because sometimes, beyond internal pain, there may not be any outward indicator. For example, a musculature or bone level trauma may not exhibit any outwards symptoms beyond pain. Considering the issues with the healing of wounds in diabetic patients, it can go untreated.
Signs and symptoms of diabetic foot ulcers are not always so prominent. So, if you see any discoloration on your foot, immediately get in touch with your doctor. And even if there is no discoloration and your foot has suffered some kind of force trauma, it’s best to opt for x-ray imaging or MRI imaging to ensure no internal injuries or infections.
Causes of Diabetic Foot Ulcer
Individuals with diabetes often develop foot ulcers because of the damage to blood vessels, poor circulation, and high glucose levels, which affects how quickly foot wounds can heal.
If people with type 2 diabetes have high blood sugar, they’ll have a harder time recovering from infection and ulcers.
The long-term effect of this could be nerve damage that results in loss of sensation in the foot.
Diabetic Foot Ulcer’s Treatment
Most diabetic foot ulcer treatments are designed to heal the affected area by reducing foot damage, infection, and pain. These treatments include wound care, antibiotics, blood sugar control, foot braces or casts, foot prostheses, surgical procedures on the foot or below the knee.
Foot Braces or Casts for Diabetic Foot Ulcers
Treatment for foot ulcers may include wearing a foot cast, splint, or brace to help your foot heal properly. For example, your doctor might recommend using a magnetic boot if you have foot ulcers on the bottom of your feet near the toes.
Your doctor will also provide foot braces or casts to help with foot ulcer treatment while protecting an injured foot from friction and pressure.
A common type of foot brace includes one made up of semi-rigid plastic that holds the forefoot in plantar flexion (downward angle) with the heel elevated off the ground slightly by placing it on some sort of padding under the sole.
Surgical Procedures
Diabetic foot ulcer treatment might also include foot surgery to cut away dead skin and tissue, reduce pressure on a damaged foot or take a biopsy of the foot tissue. In addition, your doctor would request an MRI scan to get a clear image of the affected area. In case you are claustrophobic, you can inquire about the availability of a wide-bore MRI or open MRI.
After that, they might perform a toe, foot, or leg amputation if other treatments do not work and the infection reaches and permeates the bone. To ensure unnecessary amputations do not occur, the doctors will order an x-ray scan of the foot to check the status of the bone.
Wound Care for Diabetic Foot Ulcers
Diabetic patients with foot ulcers are at risk of developing foot infections due to their reduced ability to fight off bacteria. Therefore, your doctor may prescribe you an ointment or antibiotics to treat the foot infection.
In addition, you can help accelerate foot ulcer healing by regularly cleaning your diabetic foot ulcer with mild soap and water during wound care. The doctor may also take an x-ray to gauge the progress of the treatment.
Your doctor may also recommend antiseptic gels or creams before you wash your feet so as not to disturb any wounds that might be present. Some common forms of treatment include:
Antibiotic ointments
These ointments are applied directly to the wound twice a day for several weeks; often used for minor wounds – debridement, or foot ulcer treatment with a foot scrub brush and soapy water – glycerin foot baths several times a day for 15 to 20 minutes.
Antibiotics
Your doctor may prescribe antibiotics as part of your diabetic foot ulcer treatment. If you develop an infection in your foot ulcer, taking antibiotics will help reduce the risk of serious complications such as gangrene.
If an antibiotic is not working, your doctor may prescribe a different one. They can assess how severe your foot ulcers and infections are by looking at their size, depth, signs of cellulitis (redness, warmth, and swelling), red streaks around the edge of the wound, and if they’ve spread to other areas on your foot.
Blood Sugar Control for Diabetic Foot Ulcers
Poor foot care can lead to foot infections in people with diabetes, delaying healing and increasing the risk of amputation.
Good foot care is an important part of diabetic foot ulcer treatment because it reduces your risk of infection. It includes monitoring your blood sugar levels to keep them within the normal range.
To prevent diabetic foot ulcers, you’ll need to check your feet daily. For signs of injury during your physical examination, even if you don’t notice any injuries at first.
Suppose you do not have foot pain but notice redness, warmth, or swelling anywhere on your foot. See your doctor right away so they can assess whether there is foot damage.
Conclusion
Diabetic foot ulcers can be prevented by making sure diabetic people wear well-fitted with good cushioning provided by diabetic shoes.
Diabetic patients should also wash their feet daily with antibacterial soap if possible. Furthermore, they should ensure that they are dried properly to prevent the development of diabetic foot ulcers.
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