Title: A Study on the Foot Ulcer Disease in Diabetic Patients and Its Treatment

Author: Dr Amit Chakraborty

 DOI:  http://dx.doi.org/10.18535/jmscr/v3i12.54

Abstract

Lower extremity complications in persons with diabetes have become an increasingly significant public health concern in both the developed and developing world. These complications, beginning with neuropathy and subsequent diabetic foot wounds frequently lead to infection and lower extremity amputation even in the absence of critical limb ischemia. In order to diminish the detrimental consequences associated with diabetic foot ulcers, a common-sense-based treatment approach must be implemented.

Many of the etiological factors contributing to the formation of diabetic foot ulceration may be identified using simple, inexpensive equipment in a clinical setting. Prevention of diabetic foot ulcers can be accomplished in a primary care setting with a brief history and screening for loss of protective sensation via the Semmes-Weinstein monofilament. Specialist clinics may quantify neuropathy, plantar foot pressure, and assess vascular status with Doppler ultrasound and ankle-brachial blood pressure indices. These measurements, in conjunction with other findings from the history and physical examination, may enable clinicians to stratify patients based on risk and help determine the type of intervention.

Other effective clinical interventions may include patient education, optimizing glycemic control, smoking cessation, and diligent foot care. Recent technological advanced combined with better understanding of the wound healing process have resulted in a myriad of advanced wound healing modalities in the treatment of diabetic foot ulcers. However, it is imperative to remember the fundamental basics in the healing of diabetic foot ulcers: adequate perfusion, debridement, infection control, and pressure mitigation. Early recognition of the etiological factors along with prompt management of diabetic foot ulcers is essential for successful outcome.

Keywords: diabetes, ulcer, prevention, infection, amputation

References

1.      Introduction. Healing chronic wounds: technologic solutions for today and tom-orrow. Adv Skin Wound Care. 2000;13 (Suppl2):4–5. 

2.      Living skin substitute can heal diabetic foot ulcer wounds.  FDA Consum. 2000;34:6.

3.      Peripheral arterial disease in people with diabetes. Diabetes Care. 2003;26:3333–41. 

4.      Incidence of end-stage renal disease among persons with diabetes—United States, 2000–2002.MMWR Morb Mortal Wkly Rep. 2005;54:1097–100. 

5.      Abbott CA, Carrington AL, et al. The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med.2002;19:377–84. 

6.      Armstrong DG. Loss of protective sensation: a practical evidence-based definition. J Foot Ankle Surg.2009;38:79–80. 

7.      Armstrong DG. The 10-g monofilament: the diagnostic divining rod for the diabetic foot? [editorial] [In Process Citation] Diabetes Care. 2000;23:887. 

8.      Armstrong DG, Athanasiou KA. The edge effect: how and why wounds grow in size and depth. Clin Podiatr Med Surg. 2008:105–108. 

9.      Armstrong DG, Jude EB. The Role of Matrix Metalloproteinases in Wound Healing. J Amer Podiatr Med Assn. 2002 In Press. 

10.  Armstrong DG, Lavery, et al. Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial.  Lancet. 2005; 366(9498):1704–10. 

11.  Armstrong DG, Lavery LA, et al. Outcomes of subatmospheric pressure dressing therapy on wounds of the diabetic foot. Ostomy Wound Manage.  2002; 48:64–8. 

12.  Armstrong DG, Lavery LA, et al. It is not what you put on, but what you take off: techniques for debriding and offloading the diabetic foot wound. Clin Infect Dis. 2004;39:S92–9. 

Corresponding Author

Dr Amit Chakraborty

Student DM, Endocrinology

Victoria Global University, National Institute For Education & Research, India