Introduction
Patients with diabetes mellitus are unable to produce enough insulin to control glucose (sugar) levels in the blood. Insulin, a hormone from the pancreas, regulates and maintains blood sugar levels. Its inadequate production leads to type 2 diabetes mellitus. Whereas resistance to insulin by the body leads to type 1 diabetes. People with diabetes always carry a high risk of complications if the glucose levels are not under control. Among the many complications, the most common is the foot ulcer that occurs in repeated trauma or pressure areas.
What Is Diabetic Foot Ulcer?
A diabetic foot ulcer usually occurs on the bottom of the foot as a wound. About 15 % of diabetic patients develop a foot ulcer and require hospitalization. The wound or sore, if poorly managed, can lead to the removal of the ulcer and the affected toe.
Who Is More Likely to Get a Diabetic Foot Ulcer?
The diabetic foot ulcer is more likely to develop in:
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Patients with type 2 diabetes mellitus.
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A patient with diabetes for more than ten years.
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Poorly controlled diabetes.
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Male patients.
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Patient with a history of diabetic foot ulcer.
What Are the Causes of Diabetic Foot Ulcer?
The two leading causes of foot ulcers are peripheral neuropathy and peripheral arterial disease.
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Peripheral neuropathy refers to nerve damage due to high blood glucose levels. The nerve damage occurs in the extremities of the body and leads to loss of sensation of pain, pressure, and temperature. Finally, the area becomes numb, and the patient does not know even if there is any injury in that region. These injuries, which are left unnoticed, lead to the development of an ulcer.
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Peripheral arterial disease affects the blood vessels at the extremities of the body. The blood supply becomes restricted, and any wound in that region takes a long time to heal.
What Are the Symptoms of Diabetic Foot Ulcer?
The symptoms of diabetic foot ulcer include:
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Numbness.
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Redness.
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Swelling.
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Skin gets darkened.
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Dry and cracked skin.
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Sore or a wound on the foot.
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A non-healing ulcer.
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Difficulty in walking.
In advanced stages,
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A foul smell is felt.
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Discharge from the wound, which indicates the presence of an infection.
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A callus (thick and hard skin formed due to friction or pressure) formation.
As mentioned above, any changes the patient feels must be consulted with the physician to prevent further complications.
What Are the Types of Diabetic Foot Ulcers?
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Neuropathic Ulcer - An ulcer that is formed due to peripheral neuropathy alone.
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Vascular Ulcer- An ulcer formed due to ischemia (restricted blood supply) without the involvement of nerve damage (neuropathy).
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Neurovascular Ulcer - An ulcer formed due to peripheral neuropathy and peripheral artery disease causing nerve damage and ischemia.
How to Find the Severity of Diabetic Foot Ulcers?
The extent and the condition of the ulcer depict its severity. The doctors use the Wagner grading system to find the severity of diabetic foot ulcers.
The most severe stage is when the ulcer has reached grade 4 or 5. Removing the affected part is the only option available for treatment in these stages. Hence, the doctor is consulted at the initial stages to avoid such circumstances.
How to Diagnose a Diabetic Foot Ulcer?
The tests to diagnose the foot ulcer are:
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X-Ray - To find the amount of bone involved in the ulcer.
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Blood or Swab Test - To find the presence of any infection.
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MRI (Magnetic Resonance Imaging) Scan - This shows the ulcer's soft tissue involvement and the presence of inflammation.
How to Treat a Diabetic Foot Ulcer?
The doctor makes a proper diagnosis after a series of tests. The aim of treatment should be to reduce the infection and promote healing. Diabetic patients are usually immunocompromised (decreased immunity to fight against infections). So, the wound is treated, and antibiotics are first given. The treatment for the ulcer includes:
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Optimizing Blood Sugar Levels - The cause of the foot ulcer is corrected. High blood sugar is the main factor in the formation of ulcers. So, the blood glucose levels are first brought down to a certain level.
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Debridement - This procedure refers to the removal of all the infected skin and tissues using a scalpel blade. The cleaned wound is then washed with an antiseptic solution.
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Relieving Pressure - The pressure in the ulcer area is reduced. A foot gear, brace, or using specialized castings, or a wheelchair helps in reducing the weight load that is put on the foot.
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Achilles Tendon Lengthening - It is a tendon on foot. This tendon is stretched to make the patient walk without bending the knee.
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Atherectomy - It is a minor surgery wherein the blocked blood vessel is cleared by inserting a catheter (a tube) to remove the clog from it.
What Are the Complications of a Diabetic Foot Ulcer?
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Amputation is one of the most feared problems leading to the loss of a toe.
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Gangrene of the foot.
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Osteomyelitis (inflammation of the underlying bone and muscle).
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A permanent deformity of the foot.
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Sepsis is a life-threatening complication where the infection spreads across the whole body.
How to Prevent a Foot Ulcer?
Proper care is followed to prevent the formation of foot ulcers.
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The feet are washed regularly with warm water. Moisturizing creams are applied on the feet to keep the skin soft without any callus formation.
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The foot should be inspected by looking and feeling it regularly. Any changes noticed must be reported to the doctor immediately.
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Do not go out barefoot. Always wear socks and shoes while going out. Socks should be made of cotton or any other material without tight elastics. Even in the house, footwear is used to prevent any injury.
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Buy orthopedic shoes that are comfortable to wear.
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The toenails must be cut carefully.
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It is not advisable for the patient to remove the callus or any lesion by themselves. The specialist is consulted for the appropriate treatment.
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Smoking is avoided. Smoking reduces blood circulation, and the amount of oxygen in the blood is also reduced. Hence, diabetic patients with smoking habits must quit as soon as possible.
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The patient can continue activities like walking, bike driving, and swimming.
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The feet are put up while sitting, and a few exercises recommended by the doctor are followed to improve the blood supply to the feet.
The instructions mentioned above are followed for a proper foot care routine. The doctor checks the feet every visit for any changes like numbness, callus, or other problems.
Conclusion
A diabetic foot ulcer is a complication that can be managed if the patient gets it checked at the right time. The patient has symptoms in the early stages which, when left unnoticed, can lead to the formation of an ulcer. Diabetic patients have low immunity and delayed wound healing which further puts them at risk of ulcer development. Hence, a proper foot care routine and regular check-ups by the doctor are followed to maintain a healthy and disease-free foot.
