Diabetic Foot Ulcer Treatment in India

What happens if diabetic foot ulcers are left untreated?

In case you don’t seek treatment for a diabetic foot ulcer in time, you will have to face the following complications:

• Skin and bone infections may occur due to severe nerve and blood vessel damage. 
• Abscess also occurs due to infection in the ulcer which will create a pocket filled with pus or blood. 
• Gangrene occurs when the blood vessels are damaged, and the blood flow to the area is cut off. The tissues in the affected area will start dying. 
• Deformities are another complication of leaving the foot ulcer untreated as it will weaken the muscles in the feet and lead to problems like hammertoes, prominent metatarsal heads, pes cavus, claw feet, etc., halting your ability to walk. 
• Charcot’s foot is another complication that often occurs in diabetic patients. The bones become so weak that they can break, and the nerve damage around the area lessens the sensation, thereby preventing from realizing this problem. As a result, you continue walking on the broken bones, and the foot shape will start to change. 
• Amputation is the last thing that might need to be done if you leave diabetic foot ulcers untreated. When the site is infected, and the tissues continue to die off, there is a higher risk that the same thing will happen to other body parts. As a result, the surgeon will have to amputate the foot to prevent the infection from spreading. 

Diagnosis before diabetic foot ulcer surgery

The doctor will inspect the foot, toes, and toenails for cuts, blisters, scratches, or ingrown toenails that can lead to the formation of foot ulcers. S/he may also ask you to stand and walk to analyze how the body weight is distributed across the bones and joints. The shape of the foot will also be checked as abnormal alignment of the foot can also increase the risk of ulcers. A vascular doctor may also recommend a few diagnostic tests to determine the best-suited treatment according to the severity of the condition. Some of the tests are- 

• 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 for the infection. 

Procedure of diabetic foot ulcer treatment

During the surgery, the doctor will use spinal anesthesia to numb the lower half of your body. Once you are under anesthesia, you won’t be able to feel any kind of pain or discomfort during the procedure. There is a chance that you might be awake during the procedure and hear the machine running. To make sure that you don’t feel stressed during the surgery, the doctor may also give you anti-anxiety pills. 

How to prepare for diabetic foot ulcer treatment?

To prepare you for diabetic foot ulcer surgery, the doctor will give you clear instructions, including:

• Stop medications like blood thinners before the surgery as they can increase the risk of excessive blood loss. 
• Stop eating or drinking at least 8 hours prior to the surgery. 
• Do not take aspirin for at least one week before the surgery. 
• Do not shave the surgical site for at least 2 days before the surgery date. 

What to expect after diabetic foot ulcer surgery?

After the surgery completes, you will most probably be asleep. You will be placed in the observation room until the anesthesia wears off. Afterward, you will be shifted to your ward. Depending on the procedure used for the treatment of diabetic foot ulcers, you may need to stay in the hospital for 24-72 hours. The doctor will closely monitor your condition after the surgery to make sure that there are no risks of complications. 

Immediately after the surgery, you will feel numbness in the lower half of the body. Later, you may feel pain or discomfort for which the doctor will prescribe painkillers. The doctor will apply a splint to cover your foot and lower leg for proper support. 

You will have to take complete bed rest for at least two days. After the doctor ensures that the wound is healing properly, you will be discharged. The doctor will also provide a detailed recovery plan to help you get back to your feet as soon as possible.

What are the non-surgical treatments for diabetic foot ulcers?

The following are the non-surgical treatments for diabetic foot ulcers-

1. Hyperbaric Oxygen Therapy- This treatment 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. 
2. 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 

Case Study

Mr. Vikram Sharma (changed name) approached Pristyn Care in January 2022. He complained of swelling in the legs, pus, discoloration of the skin, blood discharge, and an ulcer over the right heel. He was 62 years old and was diagnosed with a Grade 3 diabetic foot ulcer and was a patient of hypertension and heart disease. He also underwent CABG(Coronary Artery Bypass Grafting) in 2008, which was major surgery. 

Our medical coordinator connected him with our vascular expert Dr. Sanjit Gogoi. He asked about his medical and family history of Mr. Sharma to assess the condition. He even conducted a physical examination to check the tenderness and the amount o fare that is affected due to a diabetic foot ulcer. Dr. Gogoi noted ankle swelling, edema, lipodermatosclerosis, hyperpigmentation of the limbs, and foul-smelling discharge.

After a thorough examination, Dr. Gogoi concluded that Mr. Sharma is suffering from both diabetic foot ulcer and peripheral artery disease(PAD). The doctor then recommended debridement treatment to Mr. Sharma. During the treatment, an assistant cleaned the affected area with a solution, and later Dr. Gogoi removed the infected tissues precisely without harming blood vessels. Mr. Sharma stayed in the hospital for 3 days. He got discharged when the doctor ensured that the surgery was successful and Mr. Sharma was not showing any odd symptoms post-surgery. 

Mr. Sharma took 3 follow-up consultations, recovered successfully, and informed that he can now move his foot without any pain or discomfort.