DIABETIC FOOT ULCER

Diabetic foot ulcer is one of the major complications of Diabetes mellitus. It occurs in 15% of all patients with diabetes and precedes 84% of all lower leg amputations. Diabetics are prone to foot ulcerations due to both neurologic and vascular complications.
 
Pathophysiology- Pressure over a bony prominence has often been cited as the cause for skin breakdown in patients with diabetes. Skin breakdown occurs at far lesser loads when the pressure is applied by shear forces. The accompanying loss of protective sensation prevents the patient from being warned that intolerable loads have been applied. This leads to blister formation and full-thickness skin loss. The process is heightened in the presence of severe venous swelling, which further lowers the injury threshold. Shoes become tight due to swelling, thus increasing the direct pressure and shear forces applied to skin overlying the bony prominence. Thickened, hypertrophic nails increase pressure on the soft tissues surrounding the nails. The common result is tissue failure and ulcer formation.
Once the skin barrier is broken, wound healing can be impaired by abnormally functioning WBCs. Moreover, patients often are malnourished. Many have a marginal vascular supply, with less ability to achieve resolution of infection and wound healing.
Several risk factors increase a person with diabetes chances of developing foot problems and diabetic infections in the legs and feet.
Footwear: Poorly fitting shoes are a common cause of diabetic foot problems.
If the patient has red spots, sore spots, blisters, corns, calluses, or consistent pain associated with wearing shoes, new properly fitting footwear must be obtained as soon as possible.
If the patient has common foot abnormalities such as flat feet, bunions, or hammertoes, prescription shoes or shoe inserts may be necessary.
Nerve damage: People with long-standing or poorly controlled diabetes are at risk for having damage to the nerves in their feet. The medical term for this is peripheral neuropathy.
Because of the nerve damage, the patient may be unable to feel their feet normally. Also, they may be unable to sense the position of their feet and toes while walking and balancing. With normal nerves, a person can usually sense if their shoes are rubbing on the feet or if one part of the foot is becoming strained while walking.
A person with diabetes may not properly sense minor injuries (such as cuts, scrapes, blisters), signs of abnormal wear and tear (that turn into calluses and corns), and foot strain. Normally, people can feel if there is a stone in their shoe, then remove it immediately. A person who has diabetes may not be able to perceive a stone. Its constant rubbing can easily create a sore.
Poor circulation: Especially when poorly controlled, diabetes can lead to accelerated hardening of the arteries or atherosclerosis. When blood flow to injured tissues is poor, healing does not occur properly.
Trauma to the foot: Any trauma to the foot can increase the risk for a more serious problem to develop.
Infections
Athlete's foot, a fungal infection of the skin or toenails, can lead to more serious bacterial infections and should be treated promptly.
Ingrown toenails should be handled right away by a foot specialist. Toenail fungus should also be treated.
Smoking: Smoking any form of tobacco causes damage to the small blood vessels in the feet and legs. This damage can disrupt the healing process and is a major risk factor for infections and amputations. The importance of smoking cessation cannot be overemphasized.

Investigations-
1.History and physical examination- this include symptoms of the patient along with complete examination which include the patient's vital signs (temperature, pulse, blood pressure, and respiratory rate), examination of the sensation in the feet and legs, an examination of the circulation in the feet and legs, a thorough examination of any problem areas.
2.Laboratory test- it include complete blood count, blood sugar, kidney function test.
3.X-ray- x-rays studies of the feet or legs to assess for signs of damage to the bones or arthritis, damage from infection, foreign bodies in the soft tissues.
4.Doppler ultrasound to see the blood flow through the arteries and veins in the lower extremities.
 
Treatment-
Medications to reduce intensity of the symptoms, further infection.
Wound care- proper hygiene should be maintained.
Diabetes must be controlled.
Ill fitted footwear should be avoided.
Exercise should be regularly done in order to improve blood flow.
 
 
Role of homoeopathy
There are several medicines available in homoeopathic therapeutics which helps in healing wounds and preventing amputation. Those individuals who experience pain are prescribed homeopathic medicines which significantly relieve pain and burning sensation as well as remedies which reduce oedema, tendonitis and especially improve peripheral circulation.

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