How To Manage & Treat The Slow Healing Diabetic Foot Ulcers?

The number of diabetics has been on the rise, a concerning statistic as the disease can reduce one's life expectancy by up to 10 years. 

Often times this disease is only detected once complications such as heart attack, stroke, diabetic retinopathy, and neuropathy arise. Another commonly seen complication is diabetic foot ulcers, which is easily infected and if left untreated, can lead to necrosis of the foot. Severe cases of this condition even requires amputation. Continue reading this article to learn more about the early signs of diabetic foot ulcers and the medications used to treat them. 

Before we talk about diabetic foot ulcers, are you aware of these symptoms of diabetes?

• Feeling hungry often

• Feeling thirsty often

• Frequently urinating 

• Loss of weight despite a healthy appetite 

• Fatigue 

• Increased frequency of skin infections such as skin abscesses

If you experience any of the symptoms above, it’s time to give your doctor a visit to check your blood sugar levels. 

What are the Signs of Diabetic Foot Ulcer? 

Diabetic foot ulcers often occur at the soles of the feet due to uncontrolled blood sugar levels as well as diabetic neuropathy and peripheral vascular disease. Diabetic patients with neuropathy usually have a diminished or loss of sensation around the foot. That’s why when they get a cut or a wound, it often goes unnoticed. Adding to that, their low level of immunity further complicates wound healing.  

Signs of diabetic foot ulcer include : 

• Numbness and tingling sensation around the foot.

• Swelling of the foot.

• Changes in skin colour such as redness or hyperpigmentation of the skin.

• Foot feeling warm.

• Pus discharge on socks and shoes.

• Pain around foot.

• Fever and chills (usually happens at advanced stages when the infection has spread).

You are probably wondering about who is at high risk of developing this complication. Individuals who are more prone to this complication include : 

• Those with uncontrolled diabetes.

• Those with diabetic neuropathy.

• Overweight or obese individuals.

• Those who wear improper fitting shoes.

• Those walking without shoes.

• Smokers.

• Those who have high cholesterol levels.

Diabetic Foot Ulcer Treatment

If you are experiencing this specific complication, the first thing you have to do is consult your doctor. They will examine the ulcer and advise you on the best treatment suitable for your specific case. 

There are various treatment options for diabetic foot ulcers that are widely available in clinics or hospitals. Those include : 

1. Systemic antibiotics 

Most patients suffering from diabetic foot ulcers will need systemic antibiotics, either taken orally or through an intravenous line.

However, this treatment depends on several factors such as the severity of the infection, whether the patient already had antibiotics prior to admission, or if his wound has been infected by an antibiotic-resistant bacteria such as MRSA. Commonly used antibiotics include amoxicillin, dicloxacillin, cephalexin, clindamycin, ciprofloxacin, piperacillin/tazobactam, and imipenem. If MRSA infection is suspected, your doctor might prescribe antibiotics like vancomycin, trimethoprim-sulfamethoxazole, or linezolid. 

2. Analgesics 

Analgesics are pain-relieving medications given when patients complain of pain in the wound area. If the pain is mild, paracetamol or NSAIDs like ibuprofen, diclofenac, or aspirin are suitable to be given. Stronger analgesics such as tramadol, dihydrocodeine, and morphine can be given if patients experience severe pain that cannot be relieved by paracetamol and NSAIDs. 

3. Topical treatment 

Topical treatments can be divided into two categories:

• Antiseptic

  A type of disinfectant that is applied directly to the wound area to prevent and treat infections. A commonly used antiseptic is iodine, which can be used at home as a cleaning solution before dressing the wound.

• Topical antibiotics 

  Studies have shown that using topical antibiotics on wounds can help speed up wound healing. Topical antibiotics such as gentamicin, bacitracin C, mupirocin, and silver sulphadiazine can help prevent further spread of the infection.

Wound Care

Besides medications, wound care is very important in helping the healing process. Some of the steps in wound care include : 

1. Wound dressing

This step is important to ensure that the wound area is always clean and dry. It also has the additional benefit of removing the dead tissues so that the wound healing process can happen smoothly. Simple wound dressing consists of cleaning the wound area and covering it with gauze. Other types of wound dressings such as hydrogel, hydrocolloid, foam, and alginate dressings can also be used to hasten wound healing. 

2. Adjuvant therapy

Adjuvant therapy is mainly used to encourage the process of wound healing. Some examples are : 

• Negative pressure wound therapy

  This treatment method involves using a vacuum dressing and it is mostly for wounds with pus discharge that is difficult to heal. 

• Maggot debridement therapy

  This therapy is said to show a faster rate of wound closure and shortens the wound healing period compared to conventional methods. 

• Hyperbaric oxygen therapy

  This method increases the oxygenation and the antimicrobial effects which is able to heal chronic diabetic foot ulcers. 

3. Surgery

Surgery for diabetic foot ulcers includes debridement and reconstruction. Debridement basically means that the dead tissues are removed to promote the formation of new granulation tissues. This can be done in 2 ways - mechanical or autolytic. Reconstruction, on the other hand, is done by skin grafting or flaps to further aid in wound healing. 

How To Prevent Diabetic Foot Ulcers

Prevention is better than treatment when it comes to diabetic foot ulcers. Take these steps to prevent this complication:

1. Make sure to keep your follow-up appointments for foot examinations.  

2. Always check your feet for any swelling, wounds, or redness. 

3. Always wear shoes that fit comfortably with thick stockings, or opt for orthoses that are made specifically for diabetic patients. 

4. Frequently wash your feet and apply lotion to prevent dry skin. 

5. Keep your nails short.

6. Make sure your blood sugar levels are in control and attend follow-ups appointments.

7. If you are a smoker, quit smoking.

In conclusion, if you are at risk for diabetes or if you are a diabetic patient, please consult a doctor to make sure your blood sugar levels are within normal limits. If diabetes is controlled at an earlier stage, your risk for complications will reduce significantly and you can live a happy and healthy life without constantly worrying about your health.