Diabetic Foot Ulcers Treatment

Diabetic Foot Ulcers: No Need for Amputation

     Approximately 15% of diabetic patients will develop foot ulcers, and 14-24% of this group will require amputation. The Diabetes Association of Thailand estimated that in 2010, there would be approximately 2.1 million diabetic patients, and 27,300 people (about 3-4 people per day) would undergo foot amputation. Currently, medicine has developed Peripheral Transluminal Angioplasty (PTA) technology to reduce the risk of patients needing foot amputation.

Warning Signs of Diabetic Foot Ulcers

• Reduced hair on the foot or leg
• Skin color on the leg darkens; some cases may be pale
• Unable to feel a pulse on the top of the foot
• Feet feel cold, and the temperature of the two feet is unequal
• Chronic foot ulcers
• Thickening of the nails
• Severe cases involve gangrene of the toes

What are the Symptoms of Diabetic Foot Ulcers? 

• Early Stage: There may be no symptoms. As the narrowing and blockage increase, problems begin with leg pain when walking for a certain distance, necessitating a rest stop.   
• Later Stage: The blockage worsens, and the patient starts to walk less due to pain. Ulcers may occur that do not heal with standard treatment, leading to black or dead toes and potential limb loss. Many patients, especially those with diabetes, do not experience any leg pain until an unhealed ulcer or black/dead toes appear, which means the disease is already far advanced.

How Can I Know if I Have Diabetic Foot Disease?

     For patients suspected of having diabetic foot disease, such as those experiencing painful numbness in the legs when walking or having a foot ulcer for more than two weeks, in addition to a medical history and physical examination (which are essential in all cases), there is a screening test called the Ankle-Brachial Index (ABI). This can roughly indicate whether the patient has this underlying condition, especially in cases where symptoms are vague or absent.

Diabetic Foot Ulcers: Why is Treatment Necessary? 

     Diabetic patients, besides having problems with blocked blood vessels in the legs, also suffer from foot numbness due to the diabetes itself. When a foot ulcer occurs, it is often neglected because it is not painful, leading to the ulcer spreading. Without proper treatment, diabetic ulcers can progress and become infected, potentially requiring amputation. Severe infections can even be life-threatening. Amputating only the toe or dead tissue often does not heal the ulcer but instead causes it to spread further, potentially leading to limb loss. Therefore, diabetic foot ulcers must receive correct treatment to heal and save the limb.

Technology for Treating Diabetic Foot Ulcers

     There are several methods for treating diabetic foot ulcers caused by blocked blood vessels. Patients with only minor blockages may start with medication. In cases where the pathology is more advanced, more intensive treatment is required, such as angioplasty (catheterization and stenting) to expand the blood vessel or bypass surgery to restore blood flow to the leg. Currently, the science of angioplasty has advanced significantly. Previously, it could only expand short lengths of narrowed blood vessels, but now it can be performed even on patients with long-segment blockages, leading to improvement for most patients without the need for surgery.

Advantages of Treating Diabetic Foot Ulcers with Angioplasty 

     Angioplasty has many advantages, such as the patient avoids surgery and doesn't have a surgical wound, only a small needle puncture site on the skin. The pain is minimal, similar to a blood draw. There is no risk associated with general anesthesia; only local anesthesia is injected at the puncture site. Patients recover quickly after the procedure and can often go home the next day, avoiding hospital stays of several weeks like with surgery. It can also be performed on high-risk patients who might face dangers from surgery.   

If you discover a diabetic foot ulcer, do not be complacent, as it may lead to loss for you and your leg. Give yourself a chance before amputation.