A diabetic foot ulcer is an open wound or sore found in the bottom of the foot. Apart from a foot injury, issues in the feet such as ingrown toenails, dry skin cuts can lead to a diabetic foot ulcer and infection.
Who can get a diabetic foot ulcer?
People who have diabetes are more likely to develop foot ulcers, especially those on insulin. Also, people who have kidney, eye, and heart-related conditions on account of diabetes are more likely to have a foot ulcer. Other high-risk factors include being overweight and consumption of alcohol and tobacco.
A diabetic ulcer is preventable provided patients check their feet daily for open injuries/ wounds and keep their sugars under good control.
What causes diabetic foot ulcers?
The three main causes resulting in a diabetic foot ulcer are
- Uncontrolled diabetes
- Poor blood supply to the lower limbs especially legs
- Poor sensation in the foot
Minor injuries in the foot likely go undetected because diabetics feel no pain on account of poor sensation. Also, the wound will not heal as there is poor blood supply in their lower limbs.
The wound then gets infected and worsens due to high blood sugar levels. Most diabetics suffer from peripheral neuropathy or nerve damage along with a lack of blood flow which leads to the development of a diabetic foot ulcer.
Also, the presence of skin breaks on the feet implies an improper supply of blood to the wound area. Further, diabetics are unable to sense or feel the pain or discomfort of these foot wounds/injures and hence they are undetected and untreated.
Symptoms of Diabetic foot ulcer
Initially, injuries such as calluses, hammertoe, blisters, bunions, cracked skin conditions, and so on happen on the soles of the feet. The condition of the skin of the soles is likely to deteriorate further and worsen the injury and form an ulcer.
These ulcers are likely to go undetected if the diabetics suffer from diabetic neuropathy and feel no sensation or pain or discomfort in the ulcer area.
However, signs to look out for in these conditions are –
- Discharge from the wound with a foul smell
- Swelling, warmth, and discoloration in the wound area
- Firmness and pain when the wound is touched
- Formation of thick skin around the ulcer
- Fever and chills, if the condition of the ulcer has deteriorated further
Treatment for Diabetic Ulcers
The focus of the treatment is to heal the wound and prevent its recurrence and prevent infection. It is essential to bear in mind that a diabetic foot ulcer can further lead to cellulitis, infected foot ulcers, and osteomyelitis which are likely to hamper the recovery process and extend the healing period.
If at all the immunity of the diabetic is less, then the patient is at a high risk to contract local or systemic infections. Also, high blood sugar levels imply high chances of serious complications arising out of these infections.
The primary treatment includes,
- Controlling blood sugar levels
- Cleaning the ulcer by removing the thickened skin, dead tissue, pus, foreign debris and unhealthy tissue.
- Proper medication along with antibiotics to treat, cellulitis, and deep infection.
- Wearing special footwear or brace or special castings to relieve the pressure around the ulcerated area. Also, recommend the patient to use crutches or a wheelchair for mobility to avoid putting additional pressure on the wound area.
- Treat the wound with dressings and show it to your Plastic Surgeon, to accelerate healing.
- Wound Dressing and Care: Foot ulcers have to be kept covered and moist using suitable medications and dressings to accelerate healing and minimize the risk of infection. It is advisable to use ulcer dressings, skin substitutes, saline, and growth factors. The ulcerated area should be well circulated.
- Surgical Treatment: Non-infected foot ulcers do not require surgical treatment.
But surgical treatment is essential –
- To remove the infected bone, this condition is referred to as osteomyelitis
- To reduce pressure on the ulcerated area by excision of bones or shaving of bones
- To correct foot deformities such as bunions, hammertoes, bony bumps, etc
- To stabilize the condition of Charcot’s Foot
- To perform an endovascular surgery with placement of stents or an arterial bypass to treat peripheral vascular conditions
- To perform an amputation in the lower limb extremities i.e. from the toe or the part of the foot either to the knee or above the knee as required.
- Debridement for infected wounds: Debridement is a surgical procedure performed to remove all the accumulated dead tissues, pus, dry skin, and old blood in the wound. It is done under general anaesthesia or by localized anaesthesia in the wound area. The cleaned wound is then dressed and plaster is also applied to maintain joint health. If required, the debridement procedure is repeated after two or three days to assess the condition of the wound and facilitate the production of enzymes and proteins required for healing.
Plastic Surgery for infected diabetic ulcers
Plastic surgery is recommended depending upon the location and the extent of the infected wound. Dr Leena Jain, an expert plastic surgeon has successfully treated innumerable cases of diabetic ulcers in Mumbai.
In extreme cases wherein the wound may take longer periods to heal which could lead to re-infection, drying up of tissues, the onset of limb deformities, and even limb functionality, plastic surgery is the only way out.
Plastic surgery will focus on bringing the joint or the limb to its pre-infection status. The open wound will be covered by a flap or a skin graft depending upon the extent of the wound. A skin graft is done to cover just the wound however if vital structures within the wound are exposed then a flap is essential.
It takes a few weeks for the wound to heal and recover completely while physiotherapy helps to regain the functionality of the affected limb or the joint.
Recovery from a diabetic ulcer
The healing period can extend from weeks to several months depends upon the
- Size and the location of the wound
- The pressure exerted on the wound due to standing or walking
- Extent of swelling
- Lack of proper circulation
- Levels of blood sugar
- Wound care and treatment
Points to remember to reduce the risk of foot ulcer
- Reduce alcohol intake
- No tobacco consumption
- Reduce cholesterol levels
- Control blood sugar levels
- Wear proper socks and footwear that provide added protection
- Daily inspection of the foot for cracks, cuts, blisters, bruises, and other abnormalities