All people with diabetes can develop foot ulcers and foot pain, but good foot care can help prevent them. Treatment for diabetic foot ulcers and foot pain varies depending on their causes. Discuss any foot pain or discomfort with your doctor to ensure it’s not a serious problem, as infected ulcers can result in amputation if neglected.
A diabetic foot is a foot that exhibits any pathology that results directly from diabetes mellitus or any long-term (or "chronic") complication of diabetes mellitus. Presence of several characteristic diabetic foot pathologies such as infection, diabetic foot ulcer and neuropathic osteoarthropathy is called diabetic foot syndrome. Due to the peripheral nerve dysfunction associated with diabetes (diabetic neuropathy), patients have a reduced ability to feel pain. This means that minor injuries may remain undiscovered for a long while. People with diabetes are also at risk of developing a diabetic foot ulcer. Research estimates that the lifetime incidence of foot ulcers within the diabetic community is around 15% and may become as high as 25%.
In diabetes, peripheral nerve dysfunction can be combined with peripheral artery disease (PAD) causing poor blood circulation to the extremities (diabetic angiopathy). Around half of patients with a diabetic foot ulcer have co-existing PAD. Where wounds take a long time to heal, infection may set in and lower limb amputation may be necessary. Foot infection is the most common cause of non-traumatic amputation in people with diabetes.
Prevention of diabetic foot may include optimising metabolic control (regulating glucose levels); identification and screening of people at high risk for diabetic foot ulceration; and patient education in order to promote foot self-examination and foot care knowledge. Patients would be taught routinely to inspect their feet for hyperkeratosis, fungal infection, skin lesions and foot deformities. Control of footwear is also important as repeated trauma from tight shoes can be a triggering factor.There is however only limited evidence that patient education has a long-term impact as a preventative measure. "Of all methods proposed to prevent diabetic foot ulcers, only foot temperature-guided avoidance therapy was found beneficial in RCTs" according to a meta-analysis.
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A chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time the way most wounds do; wounds that do not heal within three months are often considered chronic.Chronic wounds seem to be detained in one or more of the phases of wound healing. For example, chronic wounds often remain in the inflammatory stage for too long. To overcome that stage and jump-start the healing process a number of factors need to be addressed such as bacterial burden, necrotic tissue, and moisture balance of the whole wound. In acute wounds, there is a precise balance between production and degradation of molecules such as collagen; in chronic wounds this balance is lost and degradation plays too large a role. Chronic wounds may never heal or may take years to do so. These wounds cause patients severe emotional and physical stress and create a significant financial burden on patients and the whole healthcare system. Acute and chronic wounds are at opposite ends of a spectrum of wound-healing types that progress toward being healed at different rates.
Common Chronic Wounds
These common wounds have different characteristics. Some types of chronic wounds are very painful while others are not painful at all. Some types of chronic wounds may appear round and others are irregular in shape. These common wounds may include the following:
Venous Stasis Ulcers – There are many valves inside our veins that, with the help of our leg muscles, return blood back to our hearts. If these valves don’t work as they should blood pools in the veins. This pooling causes swelling and an ulcer develops. A venous stasis ulcer drains heavily, is irregular in shape and is often painful. Venous stasis ulcers occur in the lower leg between the ankle and the knee.
Arterial Ulcers – An arterial ulcer is a round-shaped wound caused by impaired circulation and is often seen on the legs or feet. It will likely have even margins or edges. You may experience leg pain after exercising or at night when your legs are elevated.
Diabetic Ulcers – A diabetic ulcer is a wound that occurs on the foot, heel or toes of diabetics. Often there is little or no feeling in the feet or in the ulcer itself. Pulse is present and skin is normal or warm to the touch. Skin on the legs and feet may be dry and flaky. Pressure Ulcers (Bedsores) – A pressure ulcer is caused by prolonged sitting or lying in one position long enough to damage the skin. The ulcer may be very painful and may drain a little or a large amount. They commonly develop on the tailbone, heels, elbows, shoulder blades, knees, ankles, and the back of the head or the spine. Traumatic Ulcers – Trauma or injury to the body may cause a loss of tissue layers and may result in damage to or loss of body parts or organs. Trauma may also compromise the arterial, venous, or lymphatic systems of the body causing these common wounds. Post-Surgical Wounds – Wound infections are a common complication of surgery. Watch for any signs of these common wounds including redness around a surgical wound in the days following surgery. You may also notice redness or streaking in surrounding tissues, throbbing or intense pain, pus or collection of fluids around the surgical site, a strong, unpleasant odor, and a mild to moderate fever.
Treatment for Diabetic Foot & Chronic Wounds
Treatment of diabetic foot can be challenging and prolonged; it may include orthopaedic appliances, antimicrobial drugs and topical dressings.
Most diabetic foot infections (DFIs) require treatment with systemic antibiotics. The choice of the initial antibiotic treatment depends on several factors such as the severity of the infection, whether the patient has received another antibiotic treatment for it, and whether the infection has been caused by a micro-organism that is known to be resistant to usual antibiotics (e.g. MRSA). The objective of antibiotic therapy is to stop the infection and ensure it does not spread.
It is unclear whether any particular antibiotic is better than any other for curing infection or avoiding amputation. One trial suggested that ertapenem with or without vancomycin is more effective than tigecycline for resolving DFIs. It is also generally unclear whether different antibiotics are associated with more or fewer adverse effects.
It is recommended however that the antibiotics used for treatment of diabetic foot ulcers should be used after deep tissue culture of the wound. Tissue culture and not pus swab culture should be done. Antibiotics should be used at correct doses in order to prevent the emergence of drug resistance.
Pressure Ulcers (Bedsores) – A pressure ulcer is caused by prolonged sitting or lying in one position long enough to damage the skin. The ulcer may be very painful and may drain a little or a large amount. They commonly develop on the tailbone, heels, elbows, shoulder blades, knees, ankles, and the back of the head or the spine.
Traumatic Ulcers – Trauma or injury to the body may cause a loss of tissue layers and may result in damage to or loss of body parts or organs. Trauma may also compromise the arterial, venous, or lymphatic systems of the body causing these common wounds.
Post-Surgical Wounds – Wound infections are a common complication of surgery. Watch for any signs of these common wounds including redness around a surgical wound in the days following surgery. You may also notice redness or streaking in surrounding tissues, throbbing or intense pain, pus or collection of fluids around the surgical site, a strong, unpleasant odor, and a mild to moderate fever.
Some of the equipment and treatments we use are offered nowhere else in Kern County. •Debridement,Hyperbaric therapy,Mist therapy,Advanced biologics,Diagnostic testing (ABI segmental, vascular ultrasound, portable x-ray machine) We don’t just treat symptoms and send you out the door. We take a “whole person” approach to wellness and encourage our patients to take an active role in their health and treatment. When you come in for a visit, we will work closely with you to create a personalized treatment plan that promises the greatest relief – one that gets and keeps you healthy, mobile, and pain-free.