Diabetic Foot Ulcer Treatment &
Management | How a Vascular Surgeon can help
If you have diabetes, having too much glucose (aka sugar) in
your blood for a long time can cause some serious complications, including foot
ulcers/foot problems.
A diabetic foot is a long-term (or “chronic”)
complication which affects directly from Peripheral Arterial Disease (PAD)
and/or sensory neuropathy related to diabetes.
What Are Some Common Foot Problems With
Diabetes?
·
Athlete’s foot
·
Fungal infection of nails
·
Calluses
·
Corns
·
Blisters
·
Bunions
·
Dry skin
·
Diabetic ulcers
·
Hammertoes
·
Ingrown toenails
·
Plantar warts
Magnitude of the problem in India
·
Diabetic population : 30 million
·
Foot complications : 39 %
·
Compromised blood circulation : 6-16 %
·
Neuropathy : 30 – 50 %
·
15 % of Diabetics would develop foot ulcers in their
lifetime.
How diabetic foot problems develop
High or unstable blood sugar levels, the hallmark of diabetes, can
cause the arteries to change, which can choke off or damage nerves. This is
known as diabetic neuropathy, and it initially feels like a tingling or
pins-and-needles sensation, then burning, and finally numbness and lack of
feeling in the foot.
Diabetic foot ulcers are usually the result of minor trauma, such as a blister or
callus. They often appear under bony
pressure areas, such as the heel or bottom of the foot.
Normally, a person who develops one of these on their foot would feel pain and
walk differently or wear different shoes to avoid putting additional pressure
or friction on it. But if you have diabetic neuropathy, you won’t feel that
pain. You’ll keep wearing the same shoes and walking on it just as you always
do, leading it to turn into a more serious wound.
Unfortunately, we often don’t see people with diabetic foot ulcers
until the wound is advanced and an infection has begun to set in. They may not
have felt the pain of the wound, but the infection is now making them sick,
causing fever, chills and swelling or redness in the leg.
You may be able to avoid getting to this point by practicing some
simple foot care techniques and seeing your doctor as soon as a problem
develops.
Who are at Highest risk for developing Diabetic foot problems?
·
Uncontrolled Diabetes
·
Neglected foot care
·
Cracks/cuts/corns in foot
·
Diabetes associated Neuropathy
·
Peripheral Arterial Disease/smoking
Warning Signs of Diabetic Foot Problems
·
Wound / ulcer development
·
Foot swelling / redness
·
Foot Pain
·
Leg Cramps
·
Blue nails / Black color of toes
·
Tingling / numbness / burning in feet
How do a vascular surgeon treat
diabetic foot problems?
Vascular assessment is important part for ulcer healing process.
·
Wound cleaning procedure + Antibiotics
·
Complete non-weight bearing of the
involved extremity (Special footwear)
·
Dedicated diabetic foot wound dressing
/ VAC dressing
·
Teaching Foot care to patients
·
Revascularisation (ANGIOPLASTY / BYPASS) for non-healing wounds when needed.
Myths about Diabetic foot treatment
Myths
·
Technically not feasible to
perform
·
High chances for failure of
treatment
·
Very costly
·
Limb amputation is inevitable
·
Good quality artificial legs are
better for life style
Truth
·
Routinely performed by experts
·
Very good success rate
·
It’s a cost-effective treatment
·
Rarely required if treated timely
·
Nothing is comparable to one’s
own legs
Role of improving blood circulation in
diabetic foot
Why?: To save the foot, leg.
Goal: To Maximize foot blood circulation
for wound healing
Preventive measures to be taken
Along with treating diabetic foot conditions, there are other
things we can do to prevent further problems. If you’ve had foot or vascular
surgery to correct a problem, we’ll monitor you over the months and years
after.
If we determine at some point down the road that there’s a new
area of pressure developing, we may be able to correct it before it becomes a
problem. Surgical examples include tendon lengthening or osteotomy, in which we
cut or reshape a bone to relieve pressure.
We also may be able to avoid surgery with a non-invasive
procedure. If, for example, you have hammertoe, in which the toe bends downward
causing repeated ulcers on the tip of the toe, we could perform a percutaneous
needle tenotomy. In this procedure, we use a needle to release part of the
tendon from the bone.
Diabetes care doesn’t stop at controlling blood sugar. If you or a
loved one has diabetes, get in the habit of practicing proper foot care,
scheduling regular check-ups, and seeking early treatment for problems to
prevent serious diabetic foot complications, including amputation.
Regular Foot Care
·
Wash Dry Moisturize your feet daily to
avoid skin dryness & cracks.
·
Regularly check your feet
(self-examination) for warning signs.
·
If you have difficulty with your
vision, ask a family member to check for you.
·
Get your feet assessed annually once by
your doctor.
·
Cut your toe nails straight across, not
at corners. Gently file if any sharp edges present.
·
Avoid removing callous/corns on your
own, it may cause injury to your feet.
·
Avoid walking bare feet.
·
Don’t wear tight socks/shoes
·
Avoid direct heat application on feet
with hot water bag/electric heating pads.
·
If you find any injury/redness/crack;
immediately:- Wash and dry your feet, apply antiseptic solution
e.g. Betadine & see your diabetic foot ulcers specialist/doctor.
