Diabetic Foot Ulcer Treatment in Dallas-Fort Worth
Diabetic foot ulcers are open wounds commonly located at the base of the foot. Individuals with diabetes are mostly affected by foot ulcers. Foot ulcers forms due to the breaking down of skin tissue leading to the exposure of the underneath layers.
Diabetic foot ulcers affect approximately 15 percent of patients with diabetes. However, anyone who has diabetes have the tendency to be affected with foot ulcers depending on how well they control the diabetes and care for their foot.
Most foot ulcers are found under the big toes or the balls of the feet. Foot ulcers can affect the feet down to the inner bones. If it is not timely treated, the patient could be infected and could lead to lower-extremity amputations.
Causes of diabetic foot ulcers
Every patient with diabetes has a tendency to develop foot ulcers. There are several factors that could lead to foot ulcers.
- Poor circulation of blood is a vascular disease that leads to the inefficient flow of blood to the feet. Poor circulation of blood could lead to foot ulcers and also make it difficult for the ulcer to heal.
- Patients with diabetes can develop neuropathy after many years. Neuropathy is the inability to feel pain in the feet due to nerve damage which is caused by an increased level of blood sugar. This condition could lead to foot ulcer. High glucose levels can slow down the healing process of the foot ulcers which could lead to infection.
Other causes of foot ulcers include:
- Foot deformities
Risk factors for developing foot ulcers
The most well-known risk factors that cause foot ulcers include diabetic neuropathy, auxiliary foot disfigurement, and peripheral arterial occlusive disease. A cautious physical examination, followed by monofilament testing for neuropathy and non-invasive testing for blood vessel inadequacy, can identify patients susceptible to foot ulcers, and also identify patients who already have ulcers or other diabetic foot diseases.
Proper education regarding foot hygiene, nail care and footwear are significant so as to reduce the risk of sustaining an injury that could lead to the formation of foot ulcers. Diabetic foot complexities are the most widely recognized reason for non-traumatic lower extremity amputations. The risk of lower extremity amputations is 15 to 46 times higher in diabetic patients than in people who don’t have diabetes mellitus.
The risk factors of diabetic foot ulcers include:
- Race – The native Americans, African-Americans and Hispanics are more at risk of developing diabetic foot ulcers.
- Age – Older adults, especially older men are at higher risk of developing diabetic foot ulcers.
- Obesity – Individuals who are overweight are at higher risk of developing diabetic foot ulcers.
- Excess intake of alcohol – Individuals who drink alcohol excessively and over a long period of time could develop diabetic foot ulcers.
- Smoking – Smokers are at a higher risk of developing the condition.
- People who use insulin frequently are at higher risk.
- Patients with diabetes-related kidney
- Patients with heart disease
- Wearing of poorly fitted shoes
- Improper trimming and care of toenails
- Patients with eye disease from diabetes
Symptoms of diabetic foot ulcers
The ability to recognize diabetic foot ulcer symptoms is very crucial for early treatment and cure. If a diabetic foot ulcer is not treated on time, it can lead to infection, permanent disfigurement or lower extremity amputation.
The signs of diabetic foot ulcers are not always obvious, especially at the early stages. Sometimes, you won’t even see any signs until the ulcer has become infected. You may not feel any pain due to nerve damage and this will prevent you from knowing that you have foot ulcers.
However, you need to be very observant and take notice of every little change that takes place on your foot.
Symptoms of diabetic foot ulcers include:
- Skin discoloration around the affected area
- Loss of sensation or numbness
- Unusual swelling and warmth around the affected area
- Dry and thickened skin around the wound
- Black tissue surrounding the ulcer
- Gangrene (tissue death due to infections)
- Drainage coming out from the wound
- Bad odors from the wound
- Skin cracking
- Bleeding from the wound
- Advanced stages lead to fever
Diagnosis of diabetic foot ulcers
When diagnosing for foot ulcer, your doctor will most likely conduct a physical examination of your foot.
He or she will inspect your feet, toes and toenails for cuts, scratches, blisters, or ingrown toenails.
Your doctor will ask you some health-related questions such as the type of shoes you normally wear, the ways with which you keep your feet clean and healthy.
You may be asked to stand and walk so that the weight of your body and the pressure on your feet can be assessed. If you limp, this may indicate structural damage.
Your doctor will also examine your blood sugar level and blood circulation.
Your doctor will check the wound for infection and how deep the wound is. He/she will check if there are any infections such as cellulitis or osteomyelitis.
Your doctor will also check if you have circulatory problems, foot abnormalities or diabetic neuropathy. Any of these conditions can affect or hinder the healing process.
To check for neuropathy, your doctor will most likely check your reflexes, examine the sensation around your feet or examine your feet to know if you feel vibrations.
Your doctor may check blood circulation in your feet and legs by feeling your pulses. He/she will also check if your feet are warm and pinkish in color.
Doppler ultrasound may be used to test blood circulation in cases of weak pulses.
Your doctor may examine the severity of the ulcer by using a cotton swab or other instruments to check how deep the ulcer is. Your doctor will also check if the ulcer has eaten deep into the bones and tendons.
You may have to undergo different kinds of tests so that your doctor will know the extent or severity of the ulcer. Your doctor will also be able to know if the ulcer is infected and also if bones and tendons are affected.
The tests that you may undergo include:
- Blood tests – A blood test is done so that your doctor can screen for any form of infections. If the ulcer is reddish in color, swollen or you feel warm around the area, a blood test may also be conducted.
- MRI Scans – MRI scans are done so that your doctor can know the extent of damage caused by the ulcer. It shows the bones and reveals any inflammations that may have occurred.
- X-rays – You may undergo an X-ray so that your doctor can examine the internal bones and tendons for any infection or damages. Changes in the alignment of bones, loss of bone mass, weakened bones and fractures may occur. Early detections of any of these conditions help to prevent a worse case of amputations.
- CT Scan – You may also undergo a CT scan to check and examine internal organs and bones.
- Bacterial cultures – Your doctor may take a sample of the ulcer with a cotton bud or any other thin medical instruments to check for bacteria.
Treatment of diabetic foot ulcer
Diabetic foot ulcers should be treated at an early stage to prevent the ulcer from getting infected.
The key factors in the appropriate treatment of diabetic foot ulcers are:
- Managing blood glucose and other related health problems – Keep your blood glucose under control and ensure that you treat every health condition as early as possible.
- Preventing the ulcer from getting infected – It is very important that you keep foot ulcers from getting infected. You can keep it from getting infected by having regular foot baths, keeping the ulcer dry with frequent dressing changes, disinfecting the skin around the ulcer, enzyme treatments and dressing the ulcer with calcium alginates to prevent bacterial growth.
- Taking pressure off the area (Off-loading) – Take pressure off your feet by sitting or lying down. Off-loading pressure helps to lessen the stress exerted on the affected foot. Excessive pressure can make the ulcer expand and lead to infection. Individuals that are overweight are advised to take necessary measures to lose excess weight. Also, do not stand on your feet for a long period of time.
- Removing dead skin and tissue (Debridement) – Debridement is the removal of dead skin tissue from the surface of the wound. Removing the dead skin and other foreign substances helps to prevent infection and allows for a faster healing process.
- Applying medication and dressing the ulcer – After the dead skin tissue is removed, the wound will be cleaned and the necessary medications will be applied before it will be dressed and bandaged.
You may be given antibiotics, anti-platelets, or anti-clotting medications to prevent infection and facilitate the healing process.
You may also be prescribed over-the-counter medications and creams such as silver sulphadiazine cream, polyhexamethylene biguanide gel or solutions, iodine, and medical-grade honey in ointment or gel form.
- Surgery – Surgery is the last resort when all other conservative treatment methods have failed. Surgical procedures may be done to alleviate pressure off the affected area like shaving down the bone or removing foot deformities such as hammertoes, bunions, or bumps.
In extreme cases where the ulcer has gotten infected and refused to heal, your doctor may suggest amputation to prevent the infection from spreading to other parts of the body.