JOIN USMore often than not, diabetic patients fail to notice any wounds on their feet, for they cannot feel pain instantly.Dr Shabeer Ahmed offers a few tips to help them keep amputation at bay.
People with diabetes are at increased risk of complications from wound healing. Due to the decreased blood flow, injuries heal slowly than in people who do not have the disorder. Diabetic foot ulcer is a major complication of diabetes mellitus, and probably the major component of the diabetic foot. Many people with diabetes also have neuropathy - loss of sensation in their hands or feet, which means they do not necessarily notice an injury right away, and the sores and ulcers are usually painless for them. The primary cause is poor blood circulation which causes blood vessels to age and harden faster than normal leading to reduced sensation.
Management
Management of diabetic foot requires a thorough knowledge of the major risk factors for amputation, frequent routine evaluation and meticulous preventive maintenance. Maintaining a good blood glucose control leads to adequate blood circulation thus off loading to relieve pressure. Routine debridement should be done to remove devitalised tissue thus maintaining a moisture balance to manage exudates.
Treatment
Foot ulcers in diabetes require multidisciplinary assessment, usually by diabetes specialists and surgeons. Treatment consists of appropriate moist wound dressings, antibiotics, debridement, arterial revascularization, and platelet-rich fibrin therapies. Current protocol of treatment involves using gauze dressings soaked with Betadine. While Betadine has a bactericidal effect, it also retards epitheliasaion and growth of healthy granulation tissues. Thus both gauze and betadine are contradictory to wound healing and should be avoided wherever possible. While the treatment takes its own time, appropriate dressing of wounds help in faster healing. There are many types of dressings used to treat diabetic foot ulcers such as absorptive fillers, hydrogel dressings, and hydrocolloids. Moist wound therapy is the most followed method of wound dressing. This process involves applying a moist wound dressing to your wound and when in contact with exudates, it absorbs exudates (bacteria and infection) and becomes a soft cohesive gel. It micro-contours to the wound bed leaving no dead space for bacterial colonisations. These moist wound dressings provide a moist wound healing environment apart from an acidic environment that promotes faster recovery. These dressings also help in atraumatic painless removal unlike conventional gauze dressings. Dressings like Aquacel, DuoDerm are key dressings that should be used. In case of infected wounds, silver dressings called Aquacel Ag should be used.
Tips:
* Keeping control of blood sugar levels ensures faster healing of the wound.
* The wound should be kept clean with best available moist wound dressings in the market like – Aquacel and Duoderm.
* The dressings should be changed at regular intervals of 3-4 days depending upon the severity of the condition.
* Do not walk barefoot or expose the wound to the dust.
* Keep your dressing and the skin around it dry. Try not to wet the healthy tissue around your wound from your dressings. This can soften the healthy tissue and cause more foot problems.
* Wash your feet every single day with mild soap.
* Remove the moisture retained between the toes that can lead to skin breakdowns.
* Be cautious in nail salons as it might result in cuts and scratches.
* Moisturize your feet on a regular basis to avoid drying and cracking.
* Avoid tight socks and footwear.