Foot ulcers are one of diabetes’ grim complications and are a significant source of morbidity and mortality. Every half a minute, someone loses a lower limb due to diabetes and is the cause for nearly 50% of the world’s lower leg’s non- traumatic amputations. Taking these facts into consideration, careful treatment of diabetic foot ulcers is crucial.
What and Why
What is it
Ulcers are open sores or thickened wounds on the skin that don’t heal the way they should. You ‘re most likely to get ulcers in your feet and legs. Generally, the ulcers are used to refer to breaks in normal skin integrity. These ulcers can have a prolonged period to heal.
Why and how it happens
Most frequently, diabetic ulcers are caused due to:
- Poor blood circulation
- Hyperglycaemia (high blood sugar levels)
- Nervous damage
- Feet irritated or wounded
When there is poor blood circulation, it is a form of vascular disease in which blood does not flow efficiently. Bad circulation can also make healing ulcers harder.
High glucose levels can slow down an infected foot ulcer’s healing process, so blood sugar control is essential. People with type 2 diabetes are more vulnerable to ulcer infections.
Nerve damage is a long-term impact and can also cause sensation loss in your feet. At first, damaged nerves can feel tingly and slightly painful. Nerve damage reduces the sensitivity to foot pain and contributes to painless ulcers.
Diabetic ulcers can be recognised by drainage from the affected area and occasionally a visible lump that always isn’t hurting.
The skin tends to become dry and is a common issue in diabetes. Your feet may be more prone to cracking. Calluses, corns, and bleeding wounds may occur.
Ulcers occur for different reasons, so determining the underlying medical problem that caused the ulcer is significant.
Essentially, there are four main types of ulcers people get.
Neuropathic: This form of ulcer occurs when a patient’s feet lose sensation. It is generally observed in people with diabetes, but other causes, such as chronic alcohol abuse, may cause it. These ulcers are typically seen in weight-bearing areas, often starting as a callus or corn.
Arterial: This type of ulcer has reduced blood flow to lower extremities. These types of ulcers can be very painful and is usually found on the tips of the toes, lower legs, ankle, heel, and toe. They can easily get infected.
Venous: This is due to compromised veins. Veins are vessels that take fluid from the legs to the heart. Veins have small valves allowing blood to flow only one way back to the heart. The valves normally block the gravity tendency to pull back to the legs. Often the valves leak or stop working. If valves don’t work, the fluid collects in the legs, causing swelling. This swelling contributes to increased pressure in the venous system, causing leg discoloration and ulceration eventually. They are commonly seen inside the ankle and slow to heal.
Decubitus: This type of ulcer is caused by excessive prolonged foot pressure. In a person confined to bed, the most commonplace to see this form of ulcer occurs on the heels’ backs.
A standardized measuring system to evaluate whether a diabetic foot ulcer is responding to care is crucial, as a result, several classification systems have been proposed. Currently, no particular system is universally accepted but there are few popular classification systems. Some of the classification systems are listed below:
- Wagner Diabetic Foot Ulcer Grade Classification System
- University of Texas Diabetic Foot Ulcer Classification System
- Diabetic Ulcer Severity Score (DUSS)
- Site, Ischemia, Neuropathy, Bacterial Infection, and Depth (SINBAD) Wound Classification System
- Amit Jain’s Classification
A widely used system is Wegner Diabetic Foot Classification system according to which the ulcers are graded and appropriate treatment follows.
Diabetic ulcers are a complex problem. It is multi-factorial, multi-pathological, multi-anatomical with multi-level involvement and multi-systemic complications that require multi-disciplinary involvement. Therefore, it is unfeasible for a single classification system to predict the result in every patient and to guide a specific line of treatment for each patient using a single system that encompasses many lesions in a diabetic foot.
Foot ulcers may look almost like a wound on the flesh of the foot. Based on related conditions — like trouble with circulation and nerve damage — you may not feel specific symptoms. General foot ulcer symptoms may cause:
- Skin discoloration
- Dry, scaly skin
Treatment and Management
People with diabetes are particularly prone to ulcers. Immediately treating foot injuries is vital. Management consists of wound assessment, debridement, topical antibiotics, appropriate dressings, footwear advice, padding, or orthotics
Diabetic ulcer treatment includes:
Wound offloading is removing some weight or pressure from the wound to heal. This is achieved by using wheelchairs, crutches, or special footwear or braces.
Debridement is removing dead skin and tissue
Specialized dressings designed to help the skin heal, including “skin substitutes” and collagen-infused dressings, which provide the cellular building blocks needed to grow new and healthy skin.
Specialized dressings to remove excess moisture from the wound and antibiotic-infused dressings to treat and prevent infection
Hyperbaric oxygen chamber treatment, shown to heal wounds 75% faster than antibiotics alone. The oxygen-rich chamber environment allows cells to take more efficiently oxygen to the wound and helps kill the bacteria in infected wounds.
Surgical options Most non-infected foot ulcers are treated without surgery; but, if it fails, surgical treatment can be necessary. Types of surgical procedures to relieve pressure on the affected region include bone(s) removal or excision, and treatment of various deformities, such as hammertoes, bunions, or bony “bumps.”
Surgical revascularization improves blood flow to the area so the skin can heal properly.
There are some guidelines issued by the experts, and diabetic patients are recommended to follow these guidelines to avoid any serious complications.
- Inspection of your feet should be done daily. Call your doctor if you notice anything like cuts, blisters, redness, swelling, or any nail problem.
- Use only lukewarm water to wash your feet; the temperature of the water should be the same that is used for new born babies.
- Be gentle while washing your feet; carefully pat them dry, especially between the toes.
- Moisturise your feet to avoid itching or cracking, but don’t moisturise between the toes.
- Be careful while cutting nails
- No “bathroom surgery” to treat corns or calluses.
- Wear clean and dry socks every day. Don’t walk barefoot you might end up irritating your feet.
- Periodic foot exams should be done by the doctor. Seeing your doctor on a regular basis can help prevent the foot complications of diabetes.
Never take risks when it comes to diabetic foot ulcers and other diabetes-related wounds. If you see signs of infection, schedule a consultation with your doctor. The faster you receive healing, the less chance of an infection.