India has 2nd highest no of diabetics in world. Almost every 12th person is diabetic in India and every 10th being prediabetic. Problem is so huge that every 5th diabetic person will develop an ulcer in their lifetime. Most of the people who have diabetic foot ulcer or have a family member with ulcer will agree to the fact that ulcer is very difficult to heal.
Why so? Why is it so challenging to heal the ulcer? Here is the answer. Mostly patients or care givers just see it as small wound which definitely it is not. Diabetic foot ulcer is not just a wound, rather a systemic problem. Increased blood sugar affects all the components of foot ,be it muscle ,artery, nerve or en bone . So diabetic foot is a complex problem and requires multidisciplinary multiple specialists to manage it including Surgeon, Physician, diabetic foot nurse and dietician. Lets understand the diabetic foot ulcer.
Nerve damage – Diabetes damages all types of nerves in foot including sensory as well as motor. Damage to sensory nerves leads to loss of protective sensation meaning loosing the safety system of foot. Patient wont feel any trauma to foot, skin burn due to hot water and other small cuts go unnoticed. Skin becomes dry and and you can develop blisters, cracked heal which leads to further complications.
Vessel damage- Blood supply in diabetic foot is compromised due to blockage in arteries which leads to blackening of tissues and even trivial wounds becomes large by the time they get noticed.
What you should do to prevent it
- Do not walk barefoot
- Examine your feet daily especially near your toes and in between toes. Use a mirror to examine sole of foot .
- Wear a good quality pressure distributed footwear. It should be covering your toes preferably
- Wash your feet daily with soap and water and dry them immediately. Check the temperature of water with your hand first.
- Do not soak your feet in water.
- Moisturize your feet except in between toes.
- Check your shoes for any pebbles before wearing
- Get your blood sugar levels checked regularly
- If you are a smoker, stop as soon as you can.
When to consult a health care provider
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- Even a small wound or blister should be treated by a professionaDo not take over the counter measures for corn
- If u develop redness around nails or around ulcer
- Blackish discoloration at toe tips
- Bad smelling fluid from ulcer
- Color changes in Nails
- Whitish color in web spaces
- Numbness or tingling in toes
How do doctors treat ulcer
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- Usually involves a multidisciplinary team
- Doctors will check the depth of your ulcer, any discharge associated and even imaging to look for abscess, collection or bone involvement
- Assess the vascularity by clinical examination, doppler scan or CT angiography.
- Management involves controlling blood sugar levels, infection control, pus drainage and improving blood supply by angioplasty or bypass if feasible and providing pressure relieving footwear.
- In nutshell it needs comprehensive management keeping all the factors in mind .
What if u just treat ulcer with dressing
Wound will not heal until all the factors are not treated. If there is no blood supply wound healing is very difficult with out improving it. If pressure is not relieved ulcer will develop again. So overall strategy is treatment and prevention of recurrence .
Importance of timely care
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- It saves preventable amputation
- Prevents infection from going in bloodstream
Conclusion
Prevention of diabetic foot ulcer by proper care is best option. Get yourself checked asap if u feel any of the signs. Do not delay the treatment.
Reviewed by Dr. Tanuj Singla
MBBS, MS (AIIMS Rishikesh)
Ex-Senior Resident, PGI Chandigarh
Consultant Laparoscopic Surgeon
Guardian Hospital
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