Diabetic foot ulcer: treatment, causes, risk and tips
Diabetic foot ulcer in patients with diabetes are one of the most devastating complications and it is estimated that one in six diabetics are likely to develop ulcers.
The cause of diabetic foot ulcers is the combination of several factors: peripheral neuropathy (loss of sensitivity in the foot/dryness), bone deformities (due to poor support of the foot), and peripheral arterial disease (lack of blood flow). blood in the lower limbs).
Infection of ulcers in the lower extremities is the main cause of hospital admissions and major leg amputations in diabetic patients.
Prevention, early detection of the causes, and specialized foot care in diabetic patients are the best strategies to prevent limb amputation.
Ulcers in patients with diabetes are one of the most devastating complications and it is estimated that seven out of ten diabetics are likely to develop ulcers.
What is the diabetic foot?
Diabetic foot ulcer is an infection that occurs when blood glucose levels rise. This presents as a destruction of deep tissues. From there other alterations occur, such as high blood pressure, which causes damage to the nerves and vascular vessels. In the medium term, this condition will cause serious damage if left untreated.
It should be noted that not all diabetics have to suffer from diabetic feet. If so, there are two types of macrovascular and microvascular complications of diabetes:
Diabetic microangiopathy: complications derived from an injury to the small vessels. Among them, we highlight diabetic nephropathy, retinopathy, and neuropathy.
Diabetic macroangiopathy: caused by lesions in the large arterial vessels. Examples of this are ischemic heart disease, cerebrovascular disease, and peripheral arterial disease.
How does a diabetic foot ulcer start?
Diabetic foot ulcerations normally become easily infected and this, together with circulation problems and involvement of nerves and blood vessels, provides less blood to the tissues, which can lead to gangrene and amputation.
About 90% complete healing of diabetic foot ulcers is possible with proper care. For this reason, it is important to make a good prevention plan based on an early diagnosis of the disease.
Risk factors of diabetic foot ulcer
In addition to diabetes, the risk factors that favor the development of a diabetic foot ulcer or foot are:
*Be over 70 years old.
*Suffer social isolation.
*Have a previous amputation.
*Being a patient with peripheral vascular disease.
*Have poor blood glucose regulation.
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What types of surgeries can help with diabetic foot ulcers?
As podiatrists, we think about future foot features alongside wound healing. If a surgical procedure is proper for you, we will endorse a system that treats your ache or contamination now so you can pass greater effortlessly and with much less pain.
Procedures we may talk about include:
*Debridement to do away with useless or contaminated skin and tissue from the wound, which encourages healing.
*Skin grafts to reconstruct weakened or lacking skin, which promotes recuperation and helps limit the chance of infection. Skin can be taken from some other phase of the patient’s body, such as the thigh, or come from a donor; it relies upon every individual.
*Vascular surgery, which helps restore ideal blood go with flow to the wound site, advertising restoration, and healthier skin.
*Shaving or casting off bone to right deformities that put stress on the surrounding area, such as hammertoes, bone spurs, or bunions.
*Reconstruction of deformities such as flat or high-arched feet, which can motivate areas of excessive pressure.
*Realigning or fusing joints to tackle biomechanical defects that make bigger pressure
*Lengthening tendons to launch anxiety and take strain off an ulcer, permitting it to heal, or forestall a new one from forming.
*Amputation of a toe or the foot if tissue is severely broken or contamination will no longer end spreading. Our limb salvage group exhausts all different preferences earlier than recommending amputation.
Patients who have the most success after surgical procedures are generally those who make a sports graph for recovery. Your medical doctor will discuss with you about what to count on before, during, and after your procedure. For example, you may additionally want to have anyone remain with you for a few days or assist with errands, relying on the procedure.
Long term, you will want to maintain your nutrition, blood sugar levels, and blood glide on the song to limit the chance of recurrence. Your care crew will work with you to make manageable adjustments to aid your long-term fitness goals.
What are the causes of diabetic foot ulcer
Peripheral neuropathy is the main cause of diabetic foot ulcer, it affects the sensory nerves (alteration of peripheral sensitivity to painful stimuli) and motor nerves (atrophy of the muscles of the foot that leads to foot deformity, hammer toes, claw toes, hallux valgus…). We must add autonomic neuropathy that causes sweating dysfunction and as a consequence leads to dry skin, hyperkeratosis (hard skin), and cracks in the foot.
Peripheral vascular disease in diabetics manifests as microangiopathy characterized by arteriosclerotic lesions in different arterial regions. The most frequently affected arteries of the lower extremities are the tibial and deep femoral arteries.
Another characteristic in diabetic patients is the significant calcification that occurs in the arterial media layer. These calcifications are not obstructive but they do produce alterations in the determination of the ankle/brachial index, which must be taken into account.
Diabetic microangiopathy has long been considered a determining factor in diabetic foot ischemia, but recent studies have shown that it is not obstructive but functional. It is a factor that can favor infection but is not a determining factor in ischemia of the affected limb.
The immunopathy suffered by diabetic patients refers to the alteration of leukocyte function as a consequence of hyperglycemia and therefore favors the infection of ulcerative lesions.
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Symptoms of diabetic foot ulcer
The absence of sensitivity, poor circulation in the foot, and the appearance of ulcers in the area are some of the first symptoms of diabetic foot, in addition to others such as the following:
*Loss of sensation of pain, changes in temperature, or pressure in the foot.
*Lower muscle weakness and atrophy. The size of the foot increases and deformities also occur.
*Dryness in the foot.
*Appearance of edema and distensions at the vascular level. The wounds turn into ulcers.
*The foot may atrophy and will be more sensitive to biomechanical stress.
*Pain in the lower extremities.
*Tingling and cramps.
If you present any of these symptoms, and if there has already been a previous diagnosis of diabetes, it is best to consult with your doctor to be able to follow up.
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Diabetic foot ulcer: a serious problem for diabetics
Our feet are subjected to constant activity since they support our weight throughout the day. In the case of people who suffer from diabetes, their blood vessels are also narrower, which causes a reduction in blood flow and deterioration of the nerves that cause the anatomy of the foot to suffer alterations. This makes them people with a greater chance of suffering from foot ulcers, which is known as Diabetic Foot Syndrome.
But what is an ulcer? It is a sore or open wound that causes the loss of the epidermis, part of the dermis, and even the hypodermis and can become very deep, highlighting that they tend to heal poorly.
People who suffer from diabetes have a chance of between 15% and 25% of suffering from this type of ulcer, which is more likely in people who also suffer from obesity, hypertension, or smoking, or if diabetes is not controlled. However, 90% of diabetic foot ulcers can heal completely with proper care.
The importance of the Diabetic Foot is such in our environment that it represents the first cause of hospitalization in people with diabetes, so its diagnosis, prevention, and adequate treatment are essential.
Treatment for diabetic foot ulcers
It is important to remember again that a diabetic ulcer is not synonymous with infection. In those ulcers that have recently appeared (less than 2-3 weeks) and without signs of infection (erythema, negative probe-to-bone, acute phase reactants, etc.), the treatment should be to eliminate the causes that have produced these ulcers.
Total contact casting (YCT) has proven to be the treatment of choice in cases where it is necessary to relieve hyperpressure areas. Regarding the local treatment of the ulcer, it is mandatory to keep it clean and dry, either using mechanical or chemical agents (acetic acid, chlorhexidine, iodine, etc.) and, more recently, even biological agents such as bacteriophages.
However, none of them has demonstrated superiority over another.
Furthermore, in those cases in which there is a vascular problem that could prevent the healing of the ulcer, this must be resolved. Diabetic ulcers should heal if these 3 assumptions are met:
- There is an adequate vascular supply in the affected limb.
- The infection is treated appropriately if it exists.
- Areas of hyperpressure are eliminated or unloaded.
In the event that there is an ulcer that does not evolve favorably despite carrying out the correct treatment and eliminating the causes that generated it, surgical debridement and deep tissue samples should be considered to find out if there is an underlying infection.
Surgical debridement should also be considered in those cases in which there are images compatible with osteomyelitis or abscesses, in the septic patient with alteration of the acute phase reactants, or in those ulcers that present signs of infection (purulent drainage or surrounding erythema).
Although for many traumatologists debridement can be considered a simple surgery, it is crucial to raise awareness that it must be a meticulous process in which all necrotic and non-viable tissue is debrided and removed. It should be performed on both soft tissues and bone, looking for the paprika sign, that is, viable bleeding tissue.
In those cases in which it is necessary to eliminate a large part of the necrotic/osteomyelitis bone, it will be necessary to provide bone grafts or substitutes, which must be coated or saturated with antibiotics to improve the infection control result.
Furthermore, those cases in which fixation is mechanically necessary should be evaluated to decide if internal fixation is feasible since it provides better results in quality of life than external fixation.
However, these cases are always complex and must be evaluated and treated by units that have a multidisciplinary team of microbiologists, traumatologists, infectologists, and plastic surgeons.
Finally, with regard to antibiotic treatment, it should always be associated with surgery, since isolated antibiotic treatment has a failure rate of up to 30%, favoring the appearance of resistance. However, there are 2 cases in which isolated antibiotic treatment could be considered (with strict evolutionary control and considering debridement in case of poor evolution):
- Cellulite without collections.
- Acute localized osteomyelitis.
Initial empiric antibiotic treatment should be performed systemically. In most cases, the use of intravenous piperacillin/tazobactam is appropriate pending the results of intraoperative cultures. In those cases in which methicillin-resistant Staphylococcus aureus (MARSA) infection is suspected (previous antibiotic treatments, institutionalized patients), adding vancomycin to the previous treatment should be considered.
Regarding oral treatment, one should look for one that has adequate bioavailability and acceptable bone penetration. In this sense, the combination of high-dose ciprofloxacin (750 mg every 12 hours) and clindamycin (600 mg every 8 hours).
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Surgery for diabetic foot ulcers
It options to treat and prevent podiatric emergencies
Foot deformities can contribute to the formation of diabetic foot ulcers or hamper their healing.
Surgery to right a deformity or realign the foot can promote recovery and stop future ulcers.
Diabetic foot ulcers: open wounds on the toes – are all too frequent in sufferers with uncontrolled blood sugar levels. In fact, 15% of humans with diabetes will journey a foot ulcer, and 1 in 5 of these will be hospitalized for the condition.
Two of the most common ailment tactics that have an effect on the toes in humans with diabetes are diabetic peripheral sensory neuropathy and peripheral arterial disease.
Peripheral arterial disorder entails harm to the medium and small arteries that provide blood and oxygen to nourish foot tissue.
Peripheral sensory neuropathy impacts more than 1/2 of human beings with diabetes. Neuropathy damages the nerves in the feet, so humans feel numbness or tingling, or sense like they have a heavy stocking or mud caked on their foot. In some cases, humans journey burning or taking pictures of pains in their feet, which are frequently worse at night.
Sensory neuropathy additionally creates a surrounding in which humans can injure their feet however no longer experience the injury. For instance, human beings with diabetic sensory neuropathy can burn their feet with bathtub water that is too warm or when they stroll on warm pavement barefoot at some stage in the summer.
Foot ulcers strengthen when the pores and skin are uncovered due to repetitive stress on the backside of the foot, or from friction from poorly becoming shoes. Normally, human beings would experience aches due to the fact their footwear is rubbing towards their feet, however, neuropathy masks the pain.
Patients frequently find their ulcers due to the fact blood leaves a stain on their stockings or on the ground – now not due to the fact they experience the ulcer. Because many sufferers with diabetes have neuropathy, once in a while they do not be aware of the wound till it grows large or will become infected.
Foot ulcers are the main purpose of foot infections in adults. Often, the mixture of ulceration, nerve damage, infection, and bad blood waft to the foot leads to toe, foot, or leg amputation in sufferers with diabetes.
Diabetic ulcers can grow to be nonhealing wounds that persist for months or even years. In some cases, the ulcers heal but return in the same spot – after you’ve had one, you’re greater in all likelihood to boost another. Getting specialized foot care is key to defending your foot and your common health. Many facilities provide different footwear and insoles, diabetes education, and ordinary foot critiques to minimize the danger of re-ulceration.
Anti-decubitus cream and solutions for ulcer treatment
When it comes to preventing the appearance of bedsores or curing existing ones, any help is little. As you already know, these wounds caused by the death or loss of vitality of the tissue at different levels are especially dangerous and frequent in patients who spend a lot of time bedridden or in the same position.
For this reason, in the Hedasa online store, we offer you a wide range of products for your treatment. Among them, we highlight the preventive anti-decubitus cream, which acts to prevent or slow down its appearance, and the anti-decubitus cream for patients with venous insufficiency. Both can be used in addition to other anti-decubitus materials to increase their benefits.
Preventive cream for bedsores
Mepentol anti-decubitus cream is a product based on fatty acids that improve cell resistance. This process favors, in the long term, the skin’s regeneration capacity, hydration, and regeneration of the skin’s hydrolipid layer. In addition, it is a product endorsed by health professionals, so it is an optimal choice for the treatment of pressure ulcers, as well as other conditions, such as burns after exposure to the sun or diaper rash.
Anti-bedsore cream for venous insufficiency
Mepentol anti-bedsore cream for venous insufficiency for external use comes in an easy-to-apply emulsion format. It is especially indicated to treat ulcers in the initial stages of the injury since its active ingredients act mainly on the epidermis.
Likewise, it generates a protective barrier for the wound that prevents the passage of harmful microorganisms and, therefore, the progression and worsening of the wound.
Finally, it is important to note that it also serves to treat other types of health problems related to circulation, such as diabetic foot or arterial ulcers.
It contains mimosa tenuiflora, a plant known for its trunk, whose properties stimulate the smooth muscle. This ingredient is also combined with aloe vera, a plant more than known for its medicinal use.
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Top 10 diabetic foot ulcer tips
10 essential tips for caring for it: Diabetes can affect the feet through 2 mechanisms :
Neurological damage: High blood sugar levels over a long period of time can cause nerve damage, reducing sensation in the feet and hands. You may feel burning, tingling, or numbness. This makes it more difficult to detect if the shoes are causing blisters if a cut has occurred, or if the water is too hot, for example.
Vascular damage: Blood flow to the feet may also be decreased due to diabetes. This makes it more difficult to heal a wound or infection.
Therefore, the fact of reduced sensitivity to pain is added to the difficulty of healing wounds (formation of ulcers that do not close) and the greater tendency of infections to become chronic. This entire process can result in the need for amputation of the foot or even the affected leg, which is why foot care is so important in diabetic people. As almost always, prevention is essential to avoid major problems and is very easy to carry out. To help you with this task, we offer you these 10 simple tips:
1. Check your feet daily
Look for scrapes or blisters, small cuts, cracked or red skin, bruises, or any other damage. If you can’t do it alone, ask someone to help you.
If this is the case, have your spouse or a family member inspect your feet and shoes for cuts, bruises, cracks, blisters, redness, or other signs of an abnormality. Call your doctor if you notice even a small wound – the earlier we can help, the better.
2. Perform correct hygiene:
It should be done with warm water (like for bathing a baby), never hot. You could burn yourself without realizing it. Dry with small touches, without rubbing, with the towel.
3. Don’t smoke
Smoking decreases blood flow to the extremities. Another reason to leave it
4. Go regularly for a check-up by a professional
The podiatrist is the foot care specialist, and you can also use your family doctor.
5. Control your diabetes
Finally, proper control of the disease is essential to maintain blood sugar levels within recommended limits. This will decrease neurological and vascular damage and the likelihood of complications.
6. Moisturize your feet carefully
Avoid putting cream between your fingers to avoid fungal infections due to moisture.
It can be any moisturizing cream, but it mustn’t contain salicylic acid, for the reason we will see below. At the pharmacy they will be able to recommend the most suitable one; There are even special ones for diabetic feet.
7. Do not cut calluses and calluses at home
You could get serious injuries. Creams and patches to remove calluses that contain salicylic acid should also not be used because, due to the decreased sensitivity of the skin, in case of excessive removal of the superficial layers, the pain would not be noticeable and could be irreversibly damaged.
The same applies to anti-wart products.
8. No electric blankets or hot water bottles
For the same reason, if they were excessively hot you wouldn’t notice them either and you could burn yourself.
9. Wear appropriate socks and stockings
They should not be too tight to avoid decreased blood flow to the feet. Likewise, they should be thin.
10. Choose your shoes well
They have to be wide and not put pressure on the finger area, especially. Check them for small stones before putting them on. You should never walk barefoot or in sandals to avoid scratches and punctures.
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FAQs for Diabetic foot ulcer
Does this disease affect all diabetics?
Approximately 15% of diabetics will have a foot injury throughout their lives and there are, among others, the following risk factors: lack of sensitivity, lack of circulation, foot deformities, poor control of the glycemia, or lack of adequate care.
How are these alterations detected before they produce the diabetic foot ulcer?
Through simple clinical examinations such as palpation of pulses in the foot or early detection of lack of sensitivity with simple and painless instruments.
What progress has been made in the fight against this complicated disease?
Much progress has been made in terms of knowledge of the causes and the therapies to follow. Through certain types of surgery and antibiotics, we can overcome many foot infections. New dressings have appeared to accelerate the healing of ulcers and vascular treatments for patients whose circulation is not adequate. Revascularization can be carried out using minimally invasive techniques, inside the patient’s arteries.
What are the repercussions of this diabetic foot ulcer problem?
The main problem is the appearance of ulcers that, if complicated, can lead to amputation, which can be part of the foot (minor amputation) or even the entire leg (major amputation). In some patients, rehabilitation cannot be carried out due to their associated diseases, so their lives becomes linked to a wheelchair. In short, loss of functionality, quality of life, and early death.
85% of diabetic amputations are preceded by a foot ulcer.
What are the symptoms that indicate that a foot ulcer in a diabetic is infected?
When the patient begins to feel pain, infection should be suspected. Other important signs are the bad smell of the wound or the appearance of necrosis.
What does the diabetic foot ulcer unit offer?
The diabetic foot ulcer unit offers different diagnostic and therapeutic techniques to treat this pathology. Some are:
- Ankle systolic pressures
- Finger pressures using digital photoplethysmography
- Endovascular treatment (angioplasty and/or stents)
- Early and aggressive drainage of septic diabetic foot
- Conservative surgery for the patient with a bone infection
- Prophylactic surgery using CMI
- Conventional surgery
- Ozone therapy
- Transcutaneous oxygen pressure
- Study of peripheral neuropathy
- Biotensometry
- Neuropad
- Ultrasound electromyography
- Imaging techniques (ultrasound, computed tomography (CT), magnetic resonance)
- Arteriography
When do I know that I have to see a diabetic foot ulcer specialist?
If you notice that the shape of your feet has been altered, your nails are ingrown or deformed, mobility in one of your feet has been limited, wounds or blisters appear, or the sensitivity in your feet or legs has been altered, it is the time to go to a specialist.
What kind of healing is there in this regard?
Once diagnosed, the diabetic foot ulcer must be treated by specialized units made up of an Angiologist and Vascular Surgeon, a podiatrist, and a nursing team specialized in wound treatment. The treatment ranges from revascularization of the affected foot, thus increasing the supply of oxygen, the study of its biomechanics and discharge, podiatric treatments in the case of ingrown toenails, interdigital injuries, or bone deformations, and a regulated protocol of specialized nursing cures with a regulated control of its evolution.
What is charcot foot or neuropathic charcot arthropathy?
It is a chronic degenerative arthropathy (joint involvement) due to loss of sensitivity in diabetic patients. The small traumas to which the joints of the foot are subjected go unnoticed by the patient and will lead to serious deformation and functional loss of the affected foot.
What exploration and tests are necessary to assess the diabetic foot ulcer?
An inspection of the condition of the skin, nails, and bones must be carried out in which possible bone deformities, thickening of the nails, atrophy of the subcutaneous cellular tissue, the disappearance of hair on the back of the foot, and pressure areas with hyperkeratosis or presence of some ulcerative lesion.
The vascular examination begins with observation of skin temperature and palpation of pulses in both lower extremities of the patient. Arterial echo-doppler allows the determination of the ankle-brachial index (T/B), it is a non-invasive test to determine possible calcification and the degree of arterial insufficiency.
What consequences can there be if you do not treat diabetic foot with creams?
The diabetic’s foot can become insensitive to certain stimuli, such as pressure or temperature (neuropathies) and ulcers can develop due to pressure in a specific area, due to lack of sensitivity, and because the wound is not easy to heal. In addition, the skin may show peeling, sores, microwounds, and lack of hydration.
How do you use or apply diabetic foot cream?
The skin of a diabetic’s foot is very dehydrated and flaky and needs to be hydrated and protected. Our cream specially formulated for diabetic feet, Dermafeet Pie D, includes a very good moisturizing and epithelializing base, and its main component contains L-Arginine, an amino acid that activates microcirculation, helping to vascularize the area and avoids the sensation of cold feet.
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