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.
Please E-mail dr_ramanand@rediffmail.com for any questions/treatment