A diabetic foot infection/ulcer is a sore/wound on the bottom of the foot caused by diabetes. A diabetic foot ulcer is usually an open sore or wound that affects a considerable number of diabetics.
It is usually located on the bottom of the foot. If left untreated, the infection can extend upwards to involve the foot, ankle and leg and also can lead to a systemic spread of toxins or infective pathogens into the rest of the body resulting in the need for emergency hospitalization and urgent surgery.
Patients with these conditions require medical treatment to heal their infection and restrict its spread. Across the globe and especially in India, diabetes is the largest cause of non-traumatic lower extremity amputations, most of which are preceded by foot ulcers.
If diabetic patients take proper care of their health and feet and stay alert, then it is possible to prevent the formation of foot ulcers and timely treatment will help heal the ulcers.
Still confused, then you should take the help of Dr Leena Jain, one of the experienced plastic surgeon in Mumbai who is also specialised in diabetic foot ulcer treatment.
Causes of diabetes foot ulcer
Along with diabetes conditions, patients who have disorders of the kidney, eye, and heart are more likely to develop a foot ulcer. Also, the consumption of tobacco and alcohol and overweight conditions can contribute to the development of foot ulcers.
There are more than 5 million diabetics in India, thus there are atleast 100 million feet at risk of developing an ulcer. The feet of diabetic patients experience less sensation on account of poor circulation and nerves dying due to long-standing diabetes, irritation, trauma, and even friction.
Their feet could suffer from nerve damage too or a vascular disease which increases the risk of infection and the body’s capacity to heal. Lastly, high or uncontrolled blood glucose levels decrease the body’s ability to fight infection and delay or prevent the healing process.
Diabetic patients with foot ulcer conditions may not experience pain thence the ulcer may be seen only when it becomes quite big.
Foul-smelling discharge from the wound discoloration and swelling of the foot.
Treatment and Diagnosis
The treating doctor focuses on treating the foot ulcer for a quick recovery to minimize the risk of infection and avoid further complications. Some of the important aspects to consider when treating a diabetic foot ulcer are,
Prevention of infection
- Offloading: Reducing the pressure in the infected area
- Debridement: involves removing the dead skin and tissue
- Regular dressings to facilitate healing
- Regular monitoring of sugar levels and maintaining them at normal levels
In case, the treating doctor discovers an infection, hospitalization would be recommended along with total wound care and consumption of antibiotics.
To prevent an existing ulcer from getting infected, it is advisable to
- Walk using appropriate footwear – never walk barefoot
- Regulate blood sugar levels to maintain them at normal levels
- Clean and dress the wound with new dressing daily
The doctor may suggest wearing special footwear or a customized cast or a brace along with the use of walking support such as crutches or a wheelchair in order to put minimal pressure on the injured foot.
Keeping on par with the modern healing protocols, the doctor may dress the wound with dressings, topically administered drugs, growth factors, ulcer dressings, and skin substitutes. The wounded area must get adequate circulation to enable healing.
The factors that determine surgical treatment are –
- The location, size, and area of the wound: superficial or deep infection
- The pressure on the wound when standing or on movement
- The inflammation and swelling in the surrounding
- Blood sugar levels
(i) Ulcer Preventive Surgeries
- Shaving or excision of bone or bones involved
- Repair of hammertoes, bunions, or bony bumps and other deformities
- Relieve pressure on the wound area- offloading surgeries
(ii) Surgery in Superficial, Non–Limb-Threatening Infections
In cases of superficial, non–limb-threatening infections, the plastic surgeon may recommend DEBRIDEMENT SURGERY: surgical removal of dead tissue, pus, etc.
Purpose of this surgery:
- removes bioburden
- removes dead tissue and tissue breaking enzymes
- opens up infective collections and allows drainage
- provides the platform to start the healing process.
Also, care should be taken not to damage the surrounding healthy areas. Most of these procedures are performed under general or spinal anaesthesia as this is a vital surgery and needs to be done thoroughly.
Post-surgical debridement, the wound should be cleaned and dressed properly along with suitable antibiotics for quick recovery. The type of dressing to be done would be decided by the surgeon.
The foot would be covered in plaster to provide rest and aid in reducing swelling.
(iii) Surgery in Deep Foot Infections
Most patients with deep foot infections require aggressive management to save the foot and to save life. This involves hospitalization and assessment of the general condition of the patient and assessment of the foot for:
- Infective involvement of bones of the foot
- Extent of infection
- Vascular status of the lower limb
- Sensations in the foot
Plan of management involves:
- Restoration of circulation in the lower limb by doing an angioplasty procedure
- Debridement surgery for the merits listed above
- Repeat debridement to assess the healing
- Plastic/Reconstructive surgery to cover the wound to facilitate healing: wounds once in the healing phase have to be covered with a graft or a flap depending on their location on the foot.
- Medical management of diabetes and nutrition
- Post surgery rehabilitation to get the patient to start walking on his feet
Diabetic patients are at a high risk of amputation if they:
- Have a widespread bone infection
- Have severe compromise in blood circulation due to atherosclerosis of vessels
- Have uncontrolled high blood sugar levels
- Have not taken timely and thorough treatment
Prevention of foot ulcers is possible
- Stopping the consumption of smoking
- Controlling sugar levels
- Controlling cholesterol levels
- Wearing proper footwear
- Daily examination of the foot for cuts, bruises, cracks, blisters, redness, ulcers especially between the toes and soles.
To sum it up,
“Our feat is to get you back on your feet”