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Diabetic Wound Care

The Ugly Truth – What diabetes can do to your foot in 10 days:


 

“The images show how quickly the infection in the diabetic man’s foot took hold – going from a red lesion on day 1 to a wound in urgent need of surgery on day 10. The 50-year-old man, who had no idea he was suffering from diabetes, developed lesions on his feet after his new shoes rubbed.”

Source: DailyMailUK

 

 

Types of diabetic wounds:

The two most common types are:

  • Wounds of external origin – Due to peripheral neuropathy (nerve damage), wounds of external origin, such as skin cuts, burns, bumps and bruises, may often go unnoticed by the diabetic patient. If external wounds go unnoticed for some time, delayed treatment can put the patient at risk for further complications.
  • Wounds of internal origin – Wounds of internal origin, such as pressure ulcers, ingrown toenails or calluses, can lead to the breakdown of skin and surrounding tissue, increasing the risk of bacterial infections.

Causes of diabetic wounds:

Diabetic wounds are most commonly caused by:

  • Poor circulation – Poor blood circulation is a form of vascular disease in which blood does not flow to your feet efficiently. Poor circulation can also make it more difficult for ulcers to heal.
  • High blood sugar (hyperglycaemia) – High glucose levels can slow down the healing process of an infected foot ulcer, so blood sugar management is critical. People with type 2 diabetes often have a harder time fighting off infections from ulcers.
  • Nerve damage – Nerve damage is a long-term effect and can eventually lead to a loss of feeling in your feet. Damaged nerves can feel tingly and painful at first. Nerve damage reduces your sensitivity to foot pain and results in painless wounds that can cause ulcers. Ulcers can be identified by drainage from the affected area and sometimes a noticeable lump that isn’t always painful.
  • Irritated or wounded feet – Dry skin is common in diabetes. It can make your skin more prone to cracking. Calluses, corns, and bleeding wounds may occur. 

Symptoms:

Diabetic ulcers almost are commonly found on the soles of the foot (diabetic foot ulcer), where skin is subject to constant pressure. Under the weight of the body, skin deteriorates and eventually becomes an open sore. These ulcers frequently form underneath calluses and cannot be felt due to diabetic neuropathy.

Symptoms of a foot ulcers include:

  • Swelling, discoloration, and warmth around the wound
  • Foul-smelling discharge seeping from the wound
  • Pain and firmness when the wound is touched
  • Callused or thickened skin surrounding the ulcer
  • Fever and chills in advanced stages of foot ulcers

Treatment:

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

  • Prevention of infection: Infections are the top concern in any diabetic wound treatment plan. Treatment with both oral and topical antibiotics are recommended for all diabetic wound patients who show signs of infection, even mild ones.
  • Off-loading: Treatment plans for diabetic patients suffering from foot or leg ulcers will always include pressure reduction or offloading. This a key factor in preventing complications. Offloading devices that may be used include removable cast walkers or healing sandals/shoes.
  • 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.
  • Applying medication or dressings to the ulcer: Typical wound dressingsused in treating diabetic wounds are those impregnated with antimicrobial agents to help fight infection. Clinicians often prescribe advanced wound care dressings that include silver or iodine which work to enhance healing by keeping your wound moist.
  • Managing blood glucose and other health problems

Home management:

  1. Wearing loose-fitting shoes made of soft suede and socks that contain extra padding for protection.
  2. Keeping the ulcer dry and covered with appropriate wound dressings.

3. Cleaning the ulcer each day and apply appropriate topical cream/ointments.

4. Avoiding excessive walking and maintain your foot moisture.

5. Blood sugar home monitoring – maintaining proper blood glucose levels to facilitate wound healing

   6. Consider taking health supplements – Diabetic ulcers typically experience slow wound healing, but definite improvements should be seen within a week of beginning treatment. An ulcer that does not heal or becomes worse should be re-evaluated by a physician as soon as possible to prevent possible complications. Taking health supplements that improve your blood circulation is a good way to promote wound healing.

 

Sources:

  1. Wound care centres https://www.woundcarecenters.org
  2. Healthline https://www.healthline.com
  3. Advanced Tissue https://www.advancedtissue.com
  4. American Podiatric Medical Association http://www.apma.org
  5. Daily Mail http://www.dailymail.co.uk