Diabetic Foot Ulcers : Proper Treatment For Better Health

 

 

Diabetes and Its Effects

     Diabetes is a chronic disease that affects blood sugar levels and can lead to various complications, including foot ulcers. These wounds often result from injuries, infections, or poor blood circulation, causing severe inflammation. Therefore, in addition to self-care and maintaining proper blood sugar levels, patients should regularly check for wounds. Prompt medical attention and appropriate treatment can promote healing and reduce the risk of amputation.

 

 

 

 

 

What is a Diabetic Ulcer?

     A diabetic ulcer is a chronic wound commonly found in diabetic patients who have poor blood sugar control. This condition can lead to vascular narrowing and peripheral neuropathy, causing numbness and loss of sensation. As a result, patients may not be aware of wounds on their feet, legs, or hands. Poor blood circulation further exacerbates the infection, leading to severe inflammation.

 

Causes of Diabetic Ulcers

     High blood sugar levels can impair nerve function and cause vascular narrowing and blockages, particularly in the feet and legs. This makes diabetic patients more prone to wounds and unaware of their presence due to reduced pain sensation. Consequently, these wounds heal slowly, become inflamed, and spread. Moreover, high blood sugar weakens the immune system, increasing the risk of infection. Long-term diabetic complications can also cause severe blood vessel blockages, leading to tissue necrosis and worsening wounds.

 

Dangers of Diabetic Ulcers

     In the early stages, diabetic ulcers may not present any noticeable symptoms. The first sign often appears when blood vessels become severely constricted, causing leg pain after walking a short distance, necessitating rest. In more advanced stages, the blockage intensifies, leading to increased pain and difficulty walking.

 

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At this point, diabetic ulcers or blackened toes may become visible. These wounds do not heal with conventional treatments and may eventually require amputation. Some patients may not experience leg pain but later discover persistent wounds that do not heal.

 

 

Characteristics of Diabetic Ulcers

1.  Slow Healing Wounds

      Due to vascular narrowing, oxygen and nutrients cannot effectively reach the affected area, delaying healing and increasing the risk of complications.

 

2.  Chronic, Hard-to-Treat Wounds

     High blood sugar levels impair nerve function, causing numbness. Patients may overlook minor injuries, leading to chronic, unhealed wounds.

 

3.  Autonomic Nerve Dysfunction

     Dysfunction in the autonomic nerves reduces oil and sweat production, resulting in dry, cracked skin that is prone to wounds.

 

4.  Foot Deformities

     Abnormal nerve signaling can lead to muscle imbalances, causing foot deformities. Thickened skin or calluses can press on underlying tissues, leading to persistent damage.

 

5.  Peripheral Sensory Loss

     Reduced sensation can prevent patients from detecting injuries, leading to chronic infections and inflammation.

 

Severity Levels of Diabetic Ulcers

Diabetic ulcers are classified into four severity levels:

 

• Level 0 No visible ulcers.
• Level 1 Presence of an ulcer without inflammation.
• Level 2 Deep ulcers exposing tendons or bones.
• Level 3 Extensive ulcers with severe infection or abscess formation.

 

 

 

 

 

Warning Signs of Diabetic Foot Ulcers

• Reduced Hair Growth Poor circulation reduces hair growth on the legs, often accompanied by pale skin.
• Darkened Skin Blood flow restrictions cause skin discoloration in the feet or fingertips.
• Absence of Foot Pulses Thickened skin may obscure the detection of foot pulses.
• Uneven Foot Temperature Poor circulation results in one foot feeling colder than the other.
• Chronic Wounds Persistent inflammation and non-healing wounds require medical attention.
• Dry, Itchy Skin and Thickened Nails This may lead to pressure sores or ingrown nails.
• Discharge and Foul Odor Pus discharge and foul-smelling wounds indicate tissue necrosis, necessitating immediate medical care.

 

Treatment for Diabetic Ulcers: Preventing Amputation

     Treatment varies based on the severity of the vascular blockage. Mild cases may be managed with medications, while more severe conditions may require balloon angioplasty or bypass surgery to restore proper blood flow to the legs. Advances in angioplasty technology have significantly improved outcomes, allowing patients with severe vascular blockages to avoid surgery and resume normal activities.

 

 

 

 

 

 

Diabetic Ulcer Care

1.  Self-Care for Minor Wounds

     Clean the wound with mild soap, dry thoroughly, apply antiseptic, and cover it with a sterile dressing. Avoid using alcohol directly on the wound as it can damage tissue.

 

2.  Medical Treatment

     If the wound shows signs of infection or pus formation, immediate medical attention is required.

 

3.  Wound Debridement

     For infected or pus-filled wounds, doctors may need to drain the abscess and remove dead tissue.

 

4.  Antibiotic Therapy

     Prescribed based on the severity and type of infection.

 

5.  Reducing Pressure on the Wound

     Patients should minimize walking. Special footwear or insoles may be recommended.

 

6.  Vascular Interventions

     In cases of severe ischemia, angioplasty or bypass surgery may be necessary.

 

 

 

 

 

Preventing Diabetic Ulcers

• Maintain Foot Hygiene Regularly wash and dry feet thoroughly, especially between the toes.
• Trim Nails Carefully Avoid cutting nails too short or causing injury.
• Wear Proper Footwear Choose well-fitted shoes to prevent pressure sores and inspect shoes for foreign objects before wearing them.
• Regular Foot Inspections Check for redness, blisters, calluses, or color changes. Seek medical advice for non-healing wounds.

 

Conclusion

     Proper diabetic wound care is crucial. If wounds heal slowly or show signs of chronic inflammation, seeking medical attention is essential to prevent complications and reduce the risk of amputation. With appropriate care, patients can maintain a normal quality of life.

 

Diabetes Specialists, Ramkhamhaeng Hospital

Ramkhamhaeng Hospital provides expert care and consultation for diabetic patients through specialized physicians, including:

 

• Dr. Suthas Horsirimanont
• Dr. Srikorn Jinadit
• Dr. Poonsak Laohachavalit

 

 

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For further inquiries, contact: Ramkhamhaeng Hospital Phone: 0 2743 9999, 0 2374 0200-16
Fax: 0 2374 0804