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Diabetic Foot Ulcer

Posted on April 26, 2018 | No Comments on Diabetic Foot Ulcer
Diabetes is one of the most prevalent diseases afflicting persons all over the world today. According to a study, it is estimated that by the year 2030, 366 million persons in the world will have diabetes. Every 30 seconds a lower limb is lost somewhere in the world due to diabetes. The risk of someone with diabetes developing a foot ulcer could be as high as 25 percent during his/ her lifetime.
A diabetic foot ulcer is defined as skin breakdown on the foot of a patient with diabetes. Non-healing foot ulcers can serve as a portal of entry of bacteria thereby causing local infection, which may lead to systemic or overwhelming infection. Diabetic patients are usually at risk for this kind of complication because they have impaired immunity compared to healthy individuals. Furthermore, wounds are less likely to heal in diabetic patients due to their physiologic impairments.
Genesis of a foot ulcer
How does a diabetic develop foot ulcers? Nerve damage can occur in patients with diabetes resulting in loss of perception to pain. Without the ability to feel pain, many problems in the insensitive foot can occur, including failure to ; recognize development of wounds or ulcers. These ulcers usually occur due to pressure or trauma applied to a particular area of the foot. Adding to this problem is the fact that patients with diabetes may have peripheral arterial disease or poor circulation. This poor circulation results in diminished blood supply to the affected foot resulting in a non-healing wound. The aforementioned are all risk factors for the development of an infected foot ulcer.
Not all diabetic foot ulcers become infected, but when they do, the patient’s life can be at risk. Clinical signs of infection include purulent secretions (pus), signs of inflammation (such as swelling, redness, warmth and tenderness), foul odor, necrotic tissue and failure of properly treated open wound to heal. If there are signs of infection, then microbial cultures of the tissue involved should be done to determine the infecting organism and appropriate antimicrobial treatment. If the infection is severe and deep, then surgical debridement is always necessary to remove devitalized or dead tissue. Patients are started on intravenous or parenteral antibiotics until improvement is seen. Bone underneath the involved tissue should also be evaluated for any signs of infection since the duration of antibiotic treatment would be longer. The initial choice of antibiotic is usually broad-spectrum to cover for organisms that are commonly seen in diabetic patients. Once clinical improvement is seen, patients can be switched to oral antimicrobials.
Foot ulcer prevention
The best way to avoid foot ulcers is by educating patients about self-management of diabetes, including how to check their feet for indications of wound formation. Once observed, they should seek consultation with their physician. New ulcers usually appear as shallow lesions on the skin, and if seen early these can be effectively treated with minimal side effects. Moreover, patients should be advised regarding proper footwear that adequately protects the foot and sufficiently alleviates pressure.
Another strategy to prevent foot ulcers is to refrain from smoking. Smoking reduces the amount of oxygen delivery to the wound site and delays proper wound healing. In addition, nicotine, carbon monoxide and hydrogen cyanide in smoke all inhibit normal cellular metabolism resulting in poor wound healing.
In conclusion, diabetes is already a serious disease. Development of potentially life threatening complications such as foot ulcers would be an additional burden to the diabetic patient. Educating the patient on early recognition and prevention of such complications is crucial in the proper management of this condition.

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