Diabetic foot ulcers are a common complication of diabetes that can have serious consequences like infection, amputation, and even death if left untreated or not managed properly. Choosing the right treatment plan is extremely important for healing foot ulcers as quickly as possible and preventing them from coming back.
This comprehensive guide will provide you with the must-know tips for selecting the best diabetic foot ulcer treatment to promote rapid healing and reduce your risk of complications.
Have the Underlying Cause Addressed First
Before deciding on wound treatments, it is vital to identify and address the underlying cause of the diabetic foot ulcer. The most common causes include:
- Poorly controlled blood sugar levels – Consistently high blood glucose causes nerve damage in the feet and impairs immune function, circulation, and wound healing. Getting blood sugar levels lowered and regulated through medication, diet, exercise, or insulin is often the first step.
- Peripheral neuropathy – Nerve damage in the feet from diabetes reduces sensation. Patients may not feel a wound or injury. Checking feet daily and wearing appropriate footwear can help prevent ulcers forming.
- Peripheral arterial disease – Narrowed arteries restrict blood flow to the feet. Smoking cessation and medications to dilate blood vessels or surgery to improve circulation may be needed.
- Foot deformities – Bunions, hammertoes, etc. can cause abnormal pressure points and friction resulting in skin breakdown. Custom orthotics or footwear can help.
- Repeated trauma or pressure – Walking without protective footwear can lead to wounds. Pressure from ill-fitting shoes also causes ulcers on the bottom of feet or sides of toes.
Getting these underlying problems under control will give diabetic foot ulcer treatments the best chance of success.
See a Podiatrist for Specialist Care
It is extremely important to have a podiatrist oversee diabetic foot ulcer treatment. A podiatrist is a doctor who specializes in comprehensive medical and surgical care of the feet and ankles.
Podiatrists receive intensive training in diabetic foot care. They can provide thorough wound assessments, tests to look for infection, advanced treatments, and effective management of risk factors. Seeing a podiatrist quickly for any foot ulcer or wound is advised.
A podiatrist will be able to:
- Perform a Doppler ultrasound or other imaging tests to assess blood flow to the wound
- Take an x-ray or MRI to determine if there is an infection in the bone (osteomyelitis)
- Check for signs of neuropathy or circulatory problems
- Surgically debride (remove) unhealthy tissue from the ulcer
- Apply specialized wound dressings and medications directly into the ulcer
- Provide prescription antibiotics if there are signs of infection
- Fit the patient with offloading devices like casts, boots or custom shoes
- Order tests to properly identify the infecting bacteria and select the right antibiotics
- Determine if hospitalization or surgery could be beneficial
Ongoing podiatric care and reassessments of the wound are important for ensuring the ulcer is healing as expected. Don’t try to self-treat a diabetic foot ulcer at home without guidance.
Debride the Ulcer Properly
Debridement refers to the removal of dead, damaged, infected, or otherwise unhealthy tissue from a wound bed. It is an essential part of diabetic foot ulcer treatment because it creates a better environment for healing.
There are several debridement techniques podiatrists may use:
- Surgical/sharp debridement – A scalpel is used to cut away dead tissue. This is the quickest method and can be done at the initial visit.
- Mechanical debridement – A high pressure water jet or wet-to-dry dressings are applied to wash away debris in the wound.
- Autolytic debridement – Special dressings help liquefy dead tissue over time so it can detach on its own.
- Enzymatic debridement – Enzyme-containing ointments break down dead tissue.
- Biologic debridement – Sterile maggots are placed into the wound to feed on bad tissue.
- Low frequency ultrasound debridement – Ultrasound waves disrupt unhealthy tissue.
Regular debridement keeps the ulcer clean so nutrients, oxygen, and treatments can better reach the healthy underlying tissue and speed up healing.
Get Any Infection Under Control
Due to the immunosuppressive effects of diabetes, infections easily develop and thrive in foot ulcers. Diabetic foot infections must be treated very quickly and aggressively with antibiotics to prevent serious complications.
Oral antibiotics are typically used first, often a broad spectrum or combination antibiotic to
cover common bacteria like Staphylococcus aureus and Streptococcus. If oral antibiotics are not strong enough to resolve the infection, intravenous (IV) antibiotics may be administered in the hospital.
The podiatrist will also surgically remove any infected tissue and drain any abscesses that have formed. Antibiotic beads or bone cement containing antibiotics might be implanted for osteomyelitis. Amputation of a toe or part of the foot may be needed in severe cases.
Culturing the wound can identify the exact strain of bacteria causing the infection so the best targeted antibiotic can be prescribed. Antibiotic therapy usually needs to continue for 1-2 weeks after the signs of infection (redness, heat, swelling, pus) have disappeared.
Improve Blood Flow to the Area
Poor circulation in the extremities caused by peripheral arterial disease significantly slows wound healing. That’s why it is imperative to improve blood flow to the foot ulcer area as much as possible.
Options to enhance circulation include:
- Medications – Vasodilators like calcium channel blockers relax blood vessels. Pentoxifylline helps reduce blood viscosity. Cilostazol prevents platelet aggregation.
- Compression stockings – Gradient pressure up the leg helps pump blood. Must be properly fitted.
- Wound dressings – Some contain nitric oxide and other compounds to dilate local blood vessels.
- Exercise – Walking and leg exercises improve general circulation. Non-weight bearing exercises may be advised.
- Smoking cessation – Quitting smoking immediately improves blood flow.
- Vascular surgery – Bypass grafts, angioplasty, and stents re-open blocked vessels. This may be done emergently for severe ischemia.
- Hyperbaric oxygen therapy – Involves breathing pure oxygen in a pressurized room.
Standard wound care protocols must also be followed consistently, including keeping the wound moist and protected, utilizing advanced dressings, controlling swelling, etc.
Get Hyperbaric Oxygen Therapy
Serious, non-healing diabetic foot ulcers often fail to improve because of decreased blood and oxygen supply to the area. Hyperbaric oxygen therapy helps overcome this.
It involves placing the patient in a specialized chamber pressurized with 100% pure oxygen. Breathing concentrated oxygen increases the amount dissolved in the bloodstream. This enhances tissue oxygenation, promotes angiogenesis, boosts immunity, and fights infection – all of which create an optimal environment for wound healing.
Treatments are done 5 times a week, for 1-2 hours a session, for 2-3 months typically. Each center offering hyperbaric oxygen therapy will have trained specialists run the sessions and monitor progress.
Conclusion
Treating a diabetic foot ulcer successfully requires a comprehensive approach that addresses underlying factors, expert wound care, infection control, oxygenation, advanced treatments, complete offloading, pain management, home care, and above all – prevention of recurrence. With proper treatment guided under the care of a podiatrist, even severe or non-healing diabetic ulcers on feet can be healed, limbs can be saved, and patients can avoid disability. If you are diagnosed with a diabetic foot ulcer, adhering to your treatment regimen is key for an optimal outcome.
