By Dr. Zeeshan Hakim, General Surgery
Foot ulcers in Diabetic patients are associated with peripheral arterial disease of the lower limb and neuropathy. This condition is more prevalent in older patients. About 5% of the diabetic patients have foot ulceration and 15% of the patients are at the lifetime risk of developing this condition.
It is common that the majority of the foot ulcerations heal in diabetic patients. There are only 5-24% chances that the patient suffering from foot ulceration will require to amputate the limb after 6-18 months of evaluation. The risk of limb amputation due to unhealed foot ulceration increases with the increasing duration of diabetes and increasing age.
Causes of Foot Ulcers-
It is common for a patient with diabetic neuropathy to develop foot ulcers. The reason is nerve damage in diabetic condition. This damage affects the sensory, motor, and autonomic fibers. Sensory neuropathy causes the inability to feel pain, heat, and pressure. Motor neuropathy results in weakened muscle, paresis, and atrophy. Autonomic fibers dysfunction leads to decreased sweating, that leads the skin prone to microbial infection, and vasodilation.
Another reason for foot ulcers in diabetic patients is Peripheral Arterial Disease. This disease is more common in diabetic patients that start at an earlier age. Patients with Peripheral Diabetic Neuropathy lose the sensation in feet that lead to repetitive injuries from internal and external factors that may lead to foot ulceration. Moreover, if the ulcer progresses further due to infections, it may lead to foot amputation.
Identification of Foot Ulceration in a Diabetic Patient-
- The physical assessment is done by identifying the skin condition of the diabetic patient and the condition of neurological, vascular, and musculoskeletal systems.
- Skin examination includes visual examination of legs and feet, particularly the plantar, dorsal, posterior, lateral, and medial surfaces. Moreover, the skin is examined by peeling off some surface and fissuring through the needle.
- Other examinations include assessment of pulses palpitations in the various areas of legs and feet.
The doctor should also record the temperature of the foot with the help of infrared thermometer held on the various areas of the foot. Increase in temperature from the metatarsal head to the distal toes is associated with sudomotor dysfunction as well as higher risk of foot ulceration.
Treatment of Foot Ulcerations in Diabetic Patients
The process of treatment of foot ulceration in a diabetic patient often include:
- Debridement of the wound
- Making the wound infection free
- Revascularization procedures
- Off-leading of the ulcers
The first step is the most important step in any form of wound, and not only in the process of treating foot ulcers. This step includes the removal of debris and necrotic tissues.
Various methods through which this can be achieved include surgical debridement, biological debridement, enzymatic debridement, and autolytic debridement. These methods also include the processes of making the wound infection free as well as revascularization.
Off-leading is as equally important as debridement of the ulcers. Studies have shown that elevated plantar pressure significantly increases the chances of development of plantar ulcers in the patients. Various methods of off-loading include Non-removable Total-Contact Cast (TCC), Removable Cast Walkers (RCW), and Instant Total-Contact Cast (ITCC).
There are many treatments and management for foot ulcers in diabetic patients. However, it is always advisable to consult a doctor or physician before opting for any treatment option. Changing lifestyle and personal hygiene will also help a diabetic person to lower the risk of foot ulcers.