Various Factors, Treating and Treatment of Diabetic Foot Ulcer Dallas, Tx.
A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes, and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, six percent will be hospitalized due to infection or other ulcer-related complication.
Diabetic foot problems, such as ulcerations, infections, and gangrene, are the most common cause of hospitalization among diabetic patients. Routine ulcer care, treatment of infections, amputations, and hospitalizations cost billions of dollars every year and place a tremendous burden on the health care system.
Diabetes is the leading cause of nontraumatic lower extremity amputations in the United States, and approximately 14 to 24 percent of patients with diabetes who develop a foot ulcer have an amputation. Research, however, has shown that the development of a foot ulcer is preventable.
Factors affect Ulcer Foot wound healing
In general, wound healing is viewed as an interaction between a complex cascade of cellular and biochemical activities culminating in the restoration of structural, functional integrity, and increased strength in injured tissues. The phases of wound healing usually go on in a fashionable and time-dependent manner. Podiatrist says that factors affect wound healing are discussed below.
Immune state
Various components of the immune system are affected in patients with diabetes.
Antioxidant systems that participate in bactericidal activity may be impaired in diabetic state, making the wounds in diabetic patients to be susceptible to infection. Diabetes is a risk factor for bacteria in patients with pneumococcal pneumonia and is linked to increased mortality.
Age
There seems to be a relationship between the ages of an individual and wound healing process. Wound healing seems to be delayed in older age.
This is possibly due to the fact that fibroblast growth and activity decrease in older people while collagen synthesis and wound contraction are also reduced in injured older people.
Disease state
Studies have reported a higher incidence of bacterial infection in diabetic women than in non-diabetic women. It seems that diabetic patients are more susceptible to wound infection.
Diet
Diet has been reported to affect wound healing. It was observed that serum albumin level of 3.5 g/dl or more is required for adequate wound healing. Decreased level of protein could negatively affect collagen synthesis thereby impairing wound healing.
Treating Diabetic Foot Ulcers
Stay off your feet to prevent pain and ulcers. This is called off-loading, and it’s helpful for all forms of diabetic foot ulcers. Pressure from walking can make an infection worse and an ulcer expand. For people who are overweight, extra pressure may be the cause of ongoing foot pain.
Doctors can remove diabetic foot ulcers with a debridement, the removal of dead skin, foreign objects, or infections that may have caused the ulcer.
An infection is a serious complication of a foot ulcer and requires immediate treatment. Not all infections are treated the same way. Tissue surrounding the ulcer may be sent to a lab to determine which antibiotic will help. If your doctor suspects a serious infection, he or she may order an X-ray to look for signs of bone infection.
Wound Assessment
Diabetic wounds fall into three categories: neuropathic, ischemic, and neuroischemic. Knowing the distinct features of each wound category is essential to identifying wound progression, infection, and healing.
Failure to properly identify the type of wound that exists can lead to an ineffective diabetic wound treatment plan, causing long-term complications or amputation.
Medications
Your doctor may prescribe antibiotics, antiplatelets, or anti-clotting medications to treat your ulcer if the infection progresses even after preventive or anti-pressure treatments.
Talk to your doctor about other health conditions you have that might increase your risk of infections by these harmful bacteria, including HIV and liver problems.
Tissue Debridement
Wound debridement, or the removal of necrotic tissue from a wound, will reduce pressure, stimulate wound healing, allow for the inspection of underlying tissue, help with secretion or wound drainage, and optimize a wound dressing’s effectiveness.
Only an experienced practitioner who knows which section of the tissue to remove without damaging blood vessels, nerves, or tendons should perform a debridement procedure.
Moisture Balance
Choosing the optimal dressing for a diabetic wound is essential to successful wound healing. The proper wound dressing will help maintain a balanced moisture environment and allow the wound to drain and heal properly.
While each wound needs to be assessed properly, some common dressings that can be used for diabetic wounds include alginates, hydrocolloids, and films.
Underlying Factors
A diabetes wound patient must be treated holistically in order to identify underlying issues and reduce risk factors that are causing wounds in the first place.
Achieving control of diabetes is difficult but essential, especially concerning blood glucose levels, proper nutrition, high blood pressure, and smoking cessation.
Surgical Procedures
Your doctor may recommend that you seek surgical help for your ulcers. A surgeon can help alleviate pressure around your ulcer by shaving down the bone or removing foot deformities such as bunions or hammertoes.
You will likely not need surgery on your ulcer. However, if no other treatment option can help your ulcer heal or progress further into infection, surgery can prevent your ulcer from becoming worse or leading to amputation.
Treatment of Diabetic foot Ulcer
Should you get a cut, treat it immediately, before it can become infected. Cleanse the affected area with soap and water daily. Dry the area well after washing, and apply an antibiotic ointment to keep the sore germ-free.
Successful treatment of diabetic foot ulcers consists of addressing these three basic issues: debridement, offloading, and infection control.
Many topical treatments are available for foot ulcers, including:
· dressings containing silver or silver sulphadiazine cream
· polyhexamethylene biguanide (PHMB) gel or solutions
· iodine (either povidone or cadexomer)
· medical grade honey in ointment or gel form
Debridement
Debridement consists of removal of all necrotic tissue, peri-wound callus, and foreign bodies down to viable tissue. Proper debridement is necessary to decrease the risk of infection and reduce peri-wound pressure, which can impede normal wound contraction and healing.
Dressings should prevent tissue dessication, absorb excess fluid, and protect the wound from contamination. There are hundreds of dressings on the market, including hydrogels, foams, calcium alginates, absorbent polymers, growth factors, and skin replacements
Offloading
For most diabetic wound treatment plans for patients suffering from foot or leg ulcers, pressure reduction or offloading is a key factor in preventing complications.
A non-removable total contact cast (TCC) redistributes pressure evenly throughout the lower leg and can reduce healing times.
Having patients use a wheelchair or crutches to completely halt weight bearing on the affected foot is the most effective method of offloading to heal a foot ulceration.
Infection control
Infections are the top concern in any diabetic wound treatment plan. Due to the high morbidity and mortality rates associated with diabetic wounds, more aggressive forms of infection control are necessary.
Topical antimicrobials can reduce bacteria, protect against further contamination, and prevent the spread of infection deeper into the wound. Typical wound dressings used in treating diabetic wounds are those impregnated with antimicrobial agents to help fight infection.
Anaerobes, such as bacteroides, peptococcus, and peptostreptococcus, are rarely the sole pathogens but are seen in mixed infections with aerobes. Patients with such wounds should be hospitalized and treated with intravenous antibiotics.
