Healing Diabetic Foot Ulcers

In my practice, I treat a lot of diabetic patients, and I see a lot of diabetic wounds. In this case, the wounds are called diabetic foot ulcers.

When evaluating diabetic foot ulcers, some of the things we look for as foot specialists are signs of infection, size of the wound, lab tests, blood sugar levels, shoes, and circulation of the feet and legs. All of these are important. Also, getting a good history from the patient is very important. We need to know how long the wound has been present, what medications have been given, and if any other treatments have been rendered yet.

As a podiatist, my main goal is to save my patients' feet. So this is a very important topic for me. We need the patient to help us do our job to heal the diabetic foot ulcer. Whether that means staying off of the foot or wearing a special boot, the doctor knows best when it comes to healing the foot ulcer. The longer the ulcer remains open, the higher incidence of infection (whether it be in the soft tissues or in the bone). And once it goes into the bone, that is when amputation occurs.

Dr. Michele Summers Colon, DPM, MS
3503 Lexington Ave.
El Monte, CA 91731
626-442-1223
www.elmontefootdoctor.com

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Please feel free to email me if you have any questions or if you would like to schedule an appointment, or you can visit our website or call our office.
dr.michele.colon@gmail.com

Diabetic Foot Infections Can Kill You!

Do you or someone in your family have diabetes? Ignoring your feet can kill you! Take a listen, save a life!

How Should a Diabetic Foot Ulcer be Treated?

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.

There are several key factors in the appropriate treatment of a diabetic foot ulcer:

•Prevention of infection.
•Taking the pressure off the area, called “off-loading.”
•Removing dead skin and tissue, called “debridement.”
•Applying medication or dressings to the ulcer.
•Managing blood glucose and other health problems.

Not all ulcers are infected; however if your podiatric physician diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

There are several important factors to keep an ulcer from becoming infected:

•Keep blood glucose levels under tight control.
•Keep the ulcer clean and bandaged.
•Cleanse the wound daily, using a wound dressing or bandage.
•Do not walk barefoot.

For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.” Patients may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the ulcer area and help to speed the healing process.

The science of wound care has advanced significantly over the past ten years. The old thought of “let the air get at it” is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full strength betadine, peroxide, whirlpools and soaking are not recommended, as this could lead to further complications.

Appropriate wound management includes the use of dressings and topically-applied medications. These range from normal saline to advanced products, such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.

For a wound to heal there must be adequate circulation to the ulcerated area. Your podiatrist can determine circulation levels with noninvasive tests.

Diabetics are losing feeling in their feet! Why?

According to the American Diabetes Association, about 15.7 million people (5.9 percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands.  Foot problems are a big risk in diabetics. Diabetics must constantly monitor their feet or face severe consequences, including amputation.

Dr’s. RESPONSE: 

Diabetics lose feeling in their feet.  This is called diabetic sensory neuropathy.  Grossly simplified, the nerves do not conduct sensations as well as they can.  This is due to a variety of factors, but commonly a higher level of sugar in the blood stream diminishes the nerve action potential.  Direct metabolic damage then occurs to the nerves, which results in neuropathy.  There are three types of neuropathies a diabetic can have.  Sensory, motor, and autonomic neuropathies are all possible. 

Sensory neuropathy, the most common type, usually presents as the first type before motor neuropathy.  It is classically described as a sock and glove distribution.  This means than the loss of sensation occurs in the same distribution as a sock.  That is, all feeling is lost or diminished below a certain level just above the ankle joint, in the same area where a sock would be around the lower leg.  A diabetic will not be able to detect sensation or will have difficulty detecting two points of discrimination.  A person can also have an absent protective threshold.  In other words, a diabetic may not be able to feel hot water when checking drawn bath water, whereas a non-diabetic would jump, pull their hand back reflexively, and say “ow!”  This example also clearly illustrates the lack of temperature discrimination.  Another sequella is diminished vibration sensation. 

Lastly, proprioception can also be affected.  Proprioception is the ability of the body to know where a limb is in space or what movement is being performed.  For example, when you close your eyes while walking over a curb, your bodys’ own sensing system takes over.  It knows just how much height is required to lift the foot over the curb.  It also knows when to expect your foot to land onto the ground above the curb and at what force should be expected.  We are able to perform this complex task because of small receptors that line our joints and detect tiny movements made by us.  These movements are interpreted by our brains like movement in space. 

Motor neuropathy is a deficit of motor coordination affecting the intrinsic muscles of the foot leading to biomechanical and structural changes of the foot.  These changes predispose the diabetics feet to ulcers and subsequent infections. 

 Another type of neuropathy that can occur is autonomic neuropathy.  The autonomic nervous system is responsible for regulating body temperature among other things.  It does this by creating sweat and directing blood flow to or away from an extremity.  Poor control would lead to reduced blood flow, lack of sweating, and other conditions.  It also is responsible for hair follicles reacting to reduce heat or gather warmth.