People with diabetes have an increased chance of developing foot sores known as Diabetic foot ulcers. One of the first signs of Diabetic foot ulcer is drainage from your foot that might stain your socks. Irritation, swelling, and redness are some of the other early symptoms.
Diabetic foot ulcers develop due to diabetic sensory, motor, and autonomic neuropathy.
Now, lets break these terms down.
Sensory neuropathy leads to loss of protective sensation. In this case, you will not be able to feel your feet.
Motor neuropathy causes biochemical abnormalities and foot deformity
Autonomic neuropathy causes viscoelastic changes in the skin like skin dryness.
Callus formation occurs due to these changes and minor trauma or inflammation due to repetitive impact in the foot maybe because of weight-bearing causes hemorrhage right under the callus that will present itself as an ulcer on removal of the callus. Damage due to ulcer occurs below the epidermis and dermis directly into the subcutaneous tissue. Other ways in which one can develop a diabetic foot ulcer is by wearing tight footwear or by direct mechanical damage by a sharp object.
The most visible serious symptom is the appearance of an eschar (black tissue) surrounding an ulcer. This is due to the absence of healthy blood flow to the area around the ulcer.
Gangrene (tissue death, due to infections) can also be observed around the ulcer. This causes symptoms like numbness, odorless discharge, and pain can occur.
If you notice these symptoms, your healthcare professional will identify the seriousness of an ulcer on a scale of 0 to 5 using the Wagner Ulcer Classification System.
0: no open lesions; may have healed lesion
1: superficial ulcer without penetration to deeper layers
2: deeper ulcer, reaching tendon, bone, or joint capsule
3: deeper tissues involved, with abscess, osteomyelitis, or tendonitis
4: gangrene in a portion of forefoot or heel
5: extensive gangrenous involvement of the entire foot
Medbound Times reached out to Dr. Shanjitha J Hussain, MD Internal Medicine for her opinion on Diabetic foot ulcers.
Most of the time, the patients with diabetic ulcers may not even realize that they have a severe wound. This is because they are unable to feel the pain. This leads to a late diagnosis, which might even end in amputation. To prevent this, we advise diabetic patients with neuropathy to do simple bedside self-evaluation at home every day. We ask them to use a mirror to examine the soles as often as possible. This picks up any small ulcers earlier.
Dr. Shanjitha J Hussain, MD Internal Medicine
Debridement:
This procedure helps in efficient wound healing. It is achieved by eliminating the wound edge tissue and non-viable wound bed. This includes removing all the excess callus present on the periphery and nonviable dermal tissue, and all the bacterial components and foreign materials. It is recommended that this procedure be performed weekly or in alternate weeks.
Offloading:
As one of the reasons for diabetic foot ulcers is pressure on the foot, Your healthcare provider may ask you to wear special shoes, brace, or a cast. To help with speedy recovery, the patient may have to use wheelchair or crutches.
Wound dressings:
There are different types of wound dressings for various types of ulcers depending on certain wound characteristics like the amount of exudate on the wound, degree of inflammation, etc.
Types:
Wet to dry dressings
Skin substitutes
dressings containing medicines
MedBound Times reached out to Dr. Raj Gopaldas Khirasaria MBBS, MD, Physician and Diabetologist for his opinion on how to look for Diabetic foot ulcers
According to the American Diabetes Association (ADA), people with diabetes should check their feet daily for cuts, blisters, corns, redness, and other changes in the skin and toenails. They should also inspect the inside of their shoes. If they find anything, they should let their doctor know.
Dr Raj Gopaldas Khirasaria, MBBS, MD, Physician and Diabetologist
Medbound Times reached out to Dr. Shreya Dave, MBBS, General Physician to give her opinion on how to prevent diabetic foot ulcers for diabetic patients.
Gayatri Prakasan: What advice do doctors give to patients who are prone to diabetic foot ulcers?
Dr. Shreya Dave: Foot ulcers are one of the most common complications that I have seen in patients suffering with diabetes. This is usually managed by the surgery department but it can be prevented since the time of diagnosis of diabetes itself. Personally, whenever I come across diabetics I advice them to opt for 'diabetic shoes' which are specially designed to minimize foot injuries that could go unnoticed. Patients who cannot afford these shoes are advised to wear socks and footwear all the time in the house and outside. Footcare must be taught to patients as soon as they are diagnosed with diabetes.
Above 550 million people worldwide have diabetes and about 18.6 million people with diabetes have diabetic foot ulcers every year. Approximately 34% of people with type 1 or 2 diabetes develop diabetic foot ulcers in their lifetime out of which 20% will undergo an amputation in the lower extremity either a minor amputation like a part of the foot or a major one, i.e., above the foot. The causes of the amputation is usually an infection or a progressive gangrene. At least 50% of diabetic foot ulcers become infected.
References:
The Healthline Editorial Team. 2024. “Diabetic Ulcers: Causes and Treatment.” Healthline. January 19, 2024. https://www.healthline.com/health/diabetic-foot-pain-and-ulcers-causes-treatments#treatment.
Dpm, Tanzim Khan. n.d. “Diabetic Foot Ulcers: Practice Essentials, Pathophysiology, Etiology.” https://emedicine.medscape.com/article/460282-overview?form=fpf.
“Diabetes - Foot Ulcers: MedlinePlus Medical Encyclopedia.” n.d. https://medlineplus.gov/ency/patientinstructions/000077.htm.
Armstrong, David G., et al. "Diabetic foot ulcers: a review." Jama 330.1 (2023): 62-75.
By Gayatri Prakasan
