Diabetic Foot Ulcer Treatment in Dallas-Fort Worth
Diabetic foot ulcers are open wounds commonly located at the base of the foot due to areas of pressure. Diabetic foot ulcers affect approximately 15 percent of patients with diabetes. However, anyone who has diabetes has the tendency to be affected with foot ulcers if they have symptoms of neuropathy.
Foot ulcers form due to the breaking down of skin tissue which can cause exposure of subcutaneous tissue, tendon, muscle, and bone.
If it is not timely treated, the patient could get an infection and could lead to lower-extremity amputations.
Causes of diabetic foot ulcers
Most patients with diabetes have 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 ulcers. 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
- Irritation and friction
- Ill-fitting shoes
- Charcot arthropathy
Risk factors for developing foot ulcers
The most well-known risk factors that cause foot ulcers include diabetic neuropathy, foot deformities, and peripheral arterial 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 to reduce the risk of sustaining an injury that could lead to the formation of foot ulcers. Foot ulcerations can cause soft tissue infection or bone infection which can lead to amputation. 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 – Native Americans, African-Americans and Hispanics
- Age – Older adults, especially older men
- Obesity – Individuals who are overweight
- Excessive intake of alcohol – Individuals who drink alcohol excessively and over a long period of time
- Smoking – Smokers are at a higher risk of developing the condition.
- People who use insulin frequently
- 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 (Diabetic Retinopathy)
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 deformity, 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 (increased redness)
- 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 a foot ulcer, your doctor will conduct a thorough physical examination of your foot to evaluate for any signs of pre-ulcerative lesions, circulation issues, or nerve damage.
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.
Further imaging and diagnostic testing may be required to evaluate the extent of wound/bone infection.
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 and progressing.
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 – You can keep it from getting infected by keeping the wound clean and keeping the ulcer dry with frequent dressing changes.
- 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. Do not walk bare feet because this can cause pressure areas to form and lead to breakdown in the skin.
- 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 sulfadiazine 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.