Diabetic Foot Ulcer Treatment

diabetic foot ulcer treatment

Diabetic foot ulcer is the most common non traumatic foot injury that end up as lower extremity amputation. Many factors are considered to be causes of diabetic foot ulcer such as infection, foot deformity, mechanical changes, atherosclerotic peripheral arterial disease, and peripheral neuropathy. 

Risk factors of diabetic foot ulcer

According to American Academy of Family Physicians, there are some risk factors for lower extremity amputation in the diabetic foot:

• Obesity
• Diabetic retinopathy (impaired vision)
• Arterial insufficiency
• Foot deformity resulting in focal areas of high pressure
• Absence of sensation because of peripheral neuropathy
• Limited joint mobility
• Uncontrolled diabetes mellitus
• Poor footwear that causes skin breakdown
• Previous history of diabetic foot ulcer

Diabetic foot ulcer staging
According to PubMed, it is important to be aware of the natural history of the diabetic foot ulcer that can be divided into five stages:

1. Stage 1 : normal foot
2. Stage 2 : high risk foot
3. Stage 3 : ulcerated foot
4. Stage 4 : infected foot
5. Stage 5 : necrotic foot

Diabetic foot ulcer treatment 

Diabetic foot ulcer treatment needs multidisciplinary management to control all aspects of healing: mechanical, microbiological, vascular, metabolic, and also educational aspects. The first thing that should be done is a good control of blood glucose, lipid profile, and blood pressure.

1. Stage 1. Goal of therapy is to prevent the development of ulcers and to promote healthy footware habit and foot care. Diabetic patients should be encouraged to use the suitable diabetic footwear and control his blood glucose, lipids, and blood pressure.
2. Stage 2. Stage 2 is when the foot has one or more these risk factors for ulceration: ischaemia, neuropathy (sensory loss), foot deformity, swelling, and callus. The presence of callus should be agressively treated.
3. Stage 3. The foot is neuropathic and neuroischaemic. Diabetic foot ulcers in stage 3 need mechanical control (relief of pressure), wound control (wound dressing, wound toilet, debridement), and may also need vascular control.
4. Stage 4. Infected foot needs antibiotics as microbiological control, and urgent wound control (surgical drainage and debridement). The goal of therapy in stage 4 is to prevent severe infection that will progress to necrosis.
5. Stage 5. Necrotic foot can be divided into wet and dry necrosis. Wet necrosis needs intravenous antibiotics, surgical care, and vascular reconstruction. Proper management of diabetic foot ulceration will reduce the number of amputations in diabetic patients.