Diabetic Foot Ulcers:
I frequently get asked by patients suffering from Diabetic Foot Ulcers, “why did I get this ulcer when I didn’t hurt my foot?”, “how did this ulcer become so bad? it was a small ulcer a few days ago!”.
The reason for my post is to share with you briefly regarding Diabetic foot ulcers (DFU).
Diabetic patients are more prone to develop ulcers because of the following reasons:
- Nerve impairment – initially starts off with loss of sense of vibration and later progresses to loss of touch, pain and temperature sensation.
- Prone to infection – diabetic patients are more prone to infection as the immune system function is reduced.
- Micro and macroangiopathy – diabetic patients are more prone to narrowing of vessels (arthrosclerosis) and this produces reduced blood supply of the limb (ischemia), this would slow down the healing process.
Sequence of events of events for a DFU is:
Stage of Cellulitis (swelling of the foot) → Stage of Spreading cellulitis (swelling spreads to wider area) → Stage of abscess (pus collection) → Stage of Gangrene → Stage of Osteomyelitis (infection of bone) → Stage of Septicemia (infection is in the blood stream).
DUF can be managed by:
- Control of diabetes – this is important because if the diabetes is not controlled, it is easier for infection to set in. With good control of diabetes, the immune system functions better and can control the infection better.
- Control of infection – infection can be controlled with proper use of antibiotics for a specific time which is based on the type and severity of the infection.
- Treatment of the Ulcer – treatments like removal of dead tissue (debridement), drainage of pus pockets, usage of betadine and hydrogen peroxide to remove slough. These various methods are used until healthy granulation tissue is seen, which indicates that the ulcer is healing.
- Various limb saving surgeries – various surgeries that are performed to save the limb of a person suffering from a DFU are: Debridement, disarticulation of toe (removal of toe), removal of infected bone (metatarsal bones), below or above knee amputation.
- Care of patients as a whole – during recovery phase which may take a few weeks to months, the care of patients should be taken into account which include nutrition of the patient, compliance to medication, education regarding health and general well-being, prevention of other systemic infections.
At Clinic Genga we know how precious limbs are, and we strive to do the best we can to save limbs using various modalities discussed above and more.