Occurring on the feet and legs, there are several steps for treating diabetic ulcers. The most common causes for the formation of ulcers are, neuropathy, trauma, and peripheral arterial disease. Before the ulcer itself can be addressed any underlying infection must be treated and cleared. In a paper written by Ingrid Kruse, DPM and Steven Edelman, MD, the etiology (cause) of the majority of foot ulcers result from a minor trauma combined with neuropathy. Treatment of ulcers starts by a thorough evaluation by your doctor. This includes assessing the neurological and vascular status and examination. Neurological function is tested by sensitivity of the wound while vascular assessment tests blood flow to the area – important in the healing process. Physical aspects of the ulcer are then documented as well as a probe to determine if the ulcer is associated with a tendon, joint, or bone, and the presence of infection. While not all doctors can treat ulcers, the Wagner and University of Texas systems are widely used to classify ulcers and administer prognosis.
Three Steps in Treating Diabetic Ulcers
Debridement is the first step in treatment. It involves removal of all dead tissue, callus, and foreign bodies, decreasing the risk of infection and pressure to aid healing. In the case of an abscess, an incision to drain and clean the tissue is essential. This small step can prevent future amputation. Following debridement the ulcer is then irrigated and dressed in order to absorb fluids and protect from contamination. Offloading, or taking body weight off the foot or leg, is very important in the healing process. A wheelchair or crutches are preferred options while removable cast walkers can also be effective. Total contact casts (TCCs) have healing rates of 73-100% however an improperly applied cast may actually complicate the healing process. Wedge shoes are another option as well. In general one of the greatest difficulties is offloading as patients often do not use the tools provided to them. Infection control is an ongoing step. Patients must check wounds and keep them clean. When an infection is contracted antibiotics are administered depending on the severity.
Treating Diabetic Ulcers – Last Resort Amputation
Kruse and Edelman’s statistics show, more than 80,000 Americans receive amputations a year due to complications of diabetes. Of those, nearly 50% will develop ulcers and infection on the other limb within 18 months and 58% will amputate the other limb in 3-5 years. Amputation due to ulcers can lead to secondary amputation and a three-year post-amputation mortality rate of 20-50%. While a source of treatment, amputation bears a high financial and emotional cost.
