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Diabetic Foot Ulcer

What is a Diabetic Foot Ulcer?

A ‘diabeticfoot’, also known as diabetic foot ulcer is a wound or an open sore that develops in diabetic patients if their leg gets injured somehow. Diabetic foot ulcers are considered as complication that arises when the skin tissues around the injury start to break down and expose the layers underneath. One of the worst things about these ulcers is that they cannot be managed through diet, exercise, or even insulin treatment. Therefore, it is always advised to get a timely treatment for a ulcer affected diabetic foot. 

Diabetic Foot Ulcer  formation

How does it form?

Wound healing is a natural mechanism of the human body. The key feature of wound healing is the repair of the lost extracellular matrix (ECM) that is the largest component of the dermal skin layer. Diabetes is one of the diseases that disturbs the wound healing process by delaying the formation of ECM. It also increases the risk of inflammation in the wounds that further delay the formation of mature granulation tissue and reduction in the wound tensile strength. 

The delayed formation of the granulation tissue is the key reason for the formation of a diabetic foot ulcer. Other factors, such as poor circulation, foot deformities, and trauma in the foot also contribute to this condition. Patients with diabetes develop neuropathy which reduces or causes a complete loss of the ability to feel pain in the feet. The nerves get damaged due to consistently elevated blood sugar levels without exhibiting pain or other symptoms. Due to this, patients often stay unaware of the blisters, cuts, and injuries in their foot which results in the formation of a diabetic foot ulcer. 

Types of disease

Neuropathic Ulcers- It occurs in the case of peripheral diabetic neuropathy.

Neuropathic Ulcers

Ischemic Ulcers- It occurs when the peripheral artery disease is present without diabetic peripheral neuropathy.

Ischemic Ulcers

Neuroischemic Ulcers- It occurs when both peripheral neuropathy and ischemia are present as a result of peripheral artery disease.

Neuroischemic Ulcers

Causes

  • Poor circulation
  • High blood sugar
  • Nerve damage
  • Hypertension
  • Venous Insufficiency

Symptoms

  • Swelling and discoloration of the skin
  • Foul-smelling discharge
  • Pain and firmness in the wound
  • Callused or thickened skin
  • Partial or complete gangrene

Diagnosis

  • X-Ray- This imaging test is used to assess the alignment of the bones in the foot that contributes to the ulcer. The X-Ray will also help to determine the bone mass loss that happened due to diabetes. 
  • MRI Scans- The magnetic resonance imaging test creates a computerized 3-D image of the soft tissues inside the body. The doctor suggests this test to determine the extent of damage caused by the ulcer and also reveal if there is any inflammation present in the foot. 
  • Blood Test- It is recommended when there are signs of infection present with the ulcer. A blood test is done to screen the infection. 
Test of Diabetic Foot Ulcer

Severity

Intact Skin

In this grade, no diabetic foot ulcers are present. However, there is a significant risk of developing one of the patients getting injured. 

Grade 1- Intact Skin

Risks & Complications

In general, the surgical complications and risks associated with diabetic foot ulcer treatment include:

  • Allergic or other reaction to the anesthesia-Everybody reacts in a different way to the anesthetic agent. Moreover, there is a possibility that you may not be aware of your allergies. Due to both these reasons, the patient may have an allergic reaction to anesthesia or his/her body may start itching.
  • Bleeding-The ulcer contains dead tissues and while they are being removed, the blood vessels underneath may need removal as well due to which the ulcer will bleed. If the ulcer is very big, there can be an excessive amount of blood loss during the treatment.
  • Pulmonary embolism

– Blood clots are also present in the ulcer which may break down and travel to the lungs resulting in a pulmonary embolism that can be fatal. 

  • Arrhythmia or heart attack (irregular heart rhythm)-

As diabetic foot ulcer surgery sometimes involves dead tissue extraction, patients feel like it is major surgery. Due to this, they feel nervous during the surgery and may suffer from arrhythmia. 

*You should know that diabetic foot ulcer treatment is not necessarily a major surgery. It completely depends on the severity of the condition. For instance, if you have an ulcer of grade 3, debridement will be enough to improve the healing of the ulcer whereas, for a grade 5 ulcer, you may require vascular reconstruction which involves tendon lengthening or transfer as the infection usually reaches the bones in this grade. 

  • Prevention of Diabetic Foot Ulcer

    Prevention

    Prevention of Diabetic Foot Ulcer

    Proper foot care can help you prevent a lot of common problems and treat them before they lead to serious complications. Here are the tips that will help you prevent foot problems:

    • Take care of your overall health diabetes and follow your doctor’s advice to keep your blood sugar levels in the ideal range. 
    • Wash your feet in warm water and test the temperature with your elbow as the nerve damage in the feet will make you unable to feel the coldness or hotness of the water. Also, make sure that you do not soak your feet and dry them well. 
    • Check your feet for sores, blisters, redness, calluses, or other injuries every day, especially if you have poor blood flow in the feet. 
    • Make sure that your feet don’t get too dry. Keep it moist using lotion but don’t put lotion between your toes. Also, make sure that you consult your doctor before using any type of lotion for the feet. 
    • If calluses or smooth corns form in the feet, use an emery board or pumice stone to remove them after you take a bath or shower. The skin in the feet will be soft during and after the shower. Hence, it will be easier to remove. 
    • Always wear stockings or socks that fit you well and have soft elastic. Also, avoid walking barefoot or wearing sandals to ensure that your feet don’t get injured. Prefer wearing closed-toed shoes or slippers. 
    • Protect your feet from extreme heat and cold.
    • Make sure that the blood flow in your feet is maintained properly. Keep your feet up while sitting, move your ankles, wiggle your toes, and don’t sit cross-legged for a longer duration. 
    • If you smoke or drink alcohol, stop as soon as possible. Both these habits can make the existing foot problem worse, especially smoking. 
    • Visit the diabetes doctor regularly and make sure that the doctor checks your feet during each checkup. 
    • If an ulcer has already formed, contact a vascular specialist without any delay. 
  • Myths & facts about Diabetic Foot Ulcer

    Myths & Facts

    Myths & facts about Diabetic Foot Ulcer

    Myth 1: Diabetic foot needs air to heal. 

    Most people have heard this from their elders. However, it is merely a myth. In comparison with an ulcer that is left open, a moist wound will heal up to five times faster than a dry wound. For better healing, it will be better if you apply topical medicine over the ulcer and keep it covered with a dressing or band-aid 24 hours a day. 

     

    Myth 2: Antibiotic medicine is necessary for foot ulcers.

    It is another myth that might have started because foot ulcers have a tendency to become infected. However, a diabetic foot ulcer only needs antibiotic medicines if the ulcer is infected. Another reason why diabetic foot ulcers patients are less likely to need antibiotics is because patients with diabetes often develop antibiotic resistance. Hence, medicine is only required if the wound is infected. 

     

    Myth 3: Alcohol is a good disinfecting agent for a diabetic foot. 

    Many people have seen this in movies that alcohol is used as a disinfectant. But do not believe everything that you see. It is true that alcohol or even hydrogen peroxide can help to disinfect the wound but they are not meant to be used for the long term. Regular use of alcohol and hydrogen peroxide will kill the unhealthy and healthy cells that will further slow down the healing process of the wound. 

When to consult a doctor?

If you are a diabetic patient, you should consult a doctor right away if you experience one or more of the following:

  • Changes in your foot shape
  • Changes in the skin in the feet, such as a wound, redness, darkness, or foul odor coming from the feet
  • Hair loss in the feet and legs
  • Sores in the affected foot.
  • Any cut or injury in the body which is not healing well.
  • Loss of feeling or sensation in the toes, feet, or legs
  • Pain or tingling sensation in the feet or legs
  • Thick or yellow toenails

Questions to ask your doctor

What is the procedure I will undergo?
Are there any other alternative treatment options besides surgery?
What benefits does surgery have in terms of pain relief and leg & foot function?
What is the success rate of diabetic foot ulcer surgery?
Will you have to undergo surgery multiple times to completely treat the foot ulcer?
What are the chances of having a diabetic foot ulcer again?
How much pain will I have after the surgery?
Will I have any disability after ulcer surgery?
When can I return to work?
When will I be able to walk again?

Treatment options & cost

The treatment of a diabetic foot ulcer starts by cleaning or disinfecting the area. If the ulcer is infected, the doctor will first prescribe antibiotics to clear up the infection and prevent it from spreading to the bone. After the wound is cleaned, a bandage will be applied to keep the wound sterile while it heals. The doctor will also show you how to do the cleaning and dressing on your own. An anti-bacterial ointment may also be provided to speed up the healing process and prevent infection. 

Off-loading or TCC (Total Contact Casting)– It is another non-surgical treatment that involves relieving the pressure from the ulcerated area through an external means. Most commonly, the doctor will ask you to stay off your feet to prevent the infection in the ulcer from getting worse. To take the load off from your feet, the doctor will recommend wearing any of the following:

  • Shoes that are specially designed for people with diabetes 
  • Casts 
  • Foot braces
  • Compression wraps 
  • Shoe inserts 

Hyperbaric Oxygen Therapy- This is a treatment that is not available in all medical centers but can be effective to a great extent in improving the healing of diabetic foot ulcers. A chamber is used where the patient lies on his/her back on a bed. The chamber is filled with 100% oxygen which increases the amount of oxygen in the bloodstream ten times. This speeds up the healing of the ulcer by stimulating the growth factors and stem cells. Sometimes, multiple sessions are done of this therapy to ensure that the wound heals properly. 

health-insurance

Insurance coverage

The diabetic foot ulcer treatment will be covered under insurance as it has the potential to turn into a life-threatening condition. Most vascular diseases are covered in health insurance policies as they are considered critical illnesses. However, the amount of coverage you have will be different depending on the insurance policy you have and the disease for which you are seeking treatment. 

Most of the insurance companies, including Star Health Insurance, New India Health Insurance, Bajaj Allianz, Religare, ICICI Lombard, etc. provide ample coverage for vascular diseases and also have an easy and simple claim process. You can choose cashless payment or reimbursement to pay for the treatment you are seeking. But make sure that you discuss everything with the insurance provider to understand the terms and conditions of the policy. 

health-insurance
recovery-rate

Recovery rate

The recovery rate after having diabetic foot ulcer surgery varies from patient to patient depending on the severity of the condition and how the patient’s body responds to the treatment. 

In most cases, the wound will take around three to six weeks or even more (in severe cases) to heal properly. Throughout the recovery period, the patient will have to wear a cast to provide support to the leg and foot during walking and other activities. And even after the cast is removed, the doctor will suggest wearing a leg brace to assist in movements, reduce the weight-bearing forces, and correct the shape of the body.  

recovery-rate

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FAQ

How common is diabetic foot ulcer?

More than 15% of patients who have diabetes suffer from diabetic foot ulcers at some point in life. Thus, it is very common to develop a foot ulcer if you don’t pay attention to the condition and manage it properly. 

Can a diabetic foot ulcer be treated at home?

No. A diabetic foot ulcer cannot and should not be treated at home. In most cases, the ulcer becomes infected which further delays the healing process increasing the chances of infection. Removing the infection is not possible with home remedies. You should always consult a doctor for proper treatment of foot ulcers. 

Why a foot ulcer won’t heal?

A foot ulcer won’t heal if you have peripheral artery disease (PAD). It will cause malfunctioning in the circulatory system which won’t allow the ulcer to heal properly. For a non-healing ulcer, you should know that there are minimally invasive treatment methods available for such ulcers. 

Can I apply a cream to a diabetic foot ulcer?

Yes. You can use certain creams or moisturizers to promote the healing of the diabetic ulcer. Doctors often advise patients that contain urea as it will create a barrier film over the wound and aids in healing. 

How do you know that your foot ulcer is infected?

The signs of infection in a diabetic foot ulcer are quite obvious. You will experience pain, tenderness, sensitiveness, and firmness in the wound. In addition to the pain, you may also notice swelling or irritation in your foot. 

What does gangrene in a foot ulcer look like?

Gangrene in the foot ulcer looks normal at first. However, as the condition becomes serious, the skin will turn pale, then gray, and ultimately purplish red. The skin tissues will start dying off and the muscles underneath will be exposed. 

Is it always important to take antibiotics for foot ulcer treatment?

No. Treatment of diabetic foot ulcers using antibiotics won’t be required if the ulcer is not infected. In case mild soft tissue infection is present, it can be treated using oral antibiotics such as clindamycin, dicloxacillin, cephalexin, etc. 

Facts and statistics around Diabetic Foot Ulcer:

  • Approximately 4.54% of newly diagnosed type-2 diabetes patients were found to have diabetic foot ulcers.
  • Out of this 4.54%, 46.1% had neuropathic, 19.7% had ischemic, and 34.2% had neuroischemic foot ulcers.
  • Globally, the prevalence of diabetic foot ulcers was 6.3% to 8.5%, which was higher in males [4.5%] than in females [3.5%].
  • A diabetic foot ulcer is higher in type 2 diabetic patients [6.4%] than in type 1 diabetics [5.5%].

 

Pristyn Care Takes Care of the Start-to-End Journey for Diabetic Foot Ulcer

Pristyn Care is one of the leading health tech startups in India dedicated to simplifying the surgical experience of patients. We not only help the patients with their digital journey but also provide complete assistance in the treatment journey.

It doesn’t matter where you reside in India, we try our best to provide medical care to everyone who needs it. We handle the various aspects of the treatment, including:

  • Scheduling the appointment with the doctor
  • Booking tests at the diagnostic labs 
  • Providing free cab service on the day of surgery
  • Flexible payment system with No-Cost EMI 
  • Providing a deluxe bed during the hospital stay 
  • Handling insurance paperwork and claim process 
  • Making follow-up appointments with the doctor 

From the moment you get in touch with us till the day you have recovered completely, our representatives will be available round-the-clock and ensure that there are no obstacles in your journey.

 

Get Advanced Treatment for Diabetic Foot Ulcer Under Vascular Experts 

Pristyn Care has the best team of vascular surgeons across major cities. Our doctors have more than 8 years of experience and have expert knowledge of the advanced treatment methods that can be used for foot ulcer treatment. You can get in touch with our doctors by making a call or filling the “Book Appointment” form. 

The doctor will discuss everything during the initial consultation and examine the ulcer. After diagnosis, the doctor will determine the best course of action to treat the ulcer effectively. If necessary, the doctor will recommend surgical treatment and use advanced USFDA-approved technology to help restore leg function and mobility.  

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