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Diabetic foot ulcer is a breakdown of the skin and sometimes deeper tissues of the foot that leads to sore formation. It is thought to occur due to abnormal pressure or mechanical stress chronically applied to the foot, usually with concomitant predisposing conditions such as peripheral sensory neuropathy, peripheral motor neuropathy, autonomic neuropathy or peripheral arterial disease. [1]
Some risk factors for developing diabetic foot infections include history of repeated foot ulcers, foot ulcers lasting for longer than 30 days, poor control over blood glucose levels, peripheral neuropathy, renal impairment, peripheral artery disease, injury or trauma to foot, walking barefoot frequently, and history of amputation in lower limbs.
Diabetics have a 15% higher risk for amputation than the general population [2] due to chronic ulcers. Diabetes causes neuropathy, which inhibits nociception and the perception of pain. [2] Thus patients may not initially notice small wounds to legs and feet, and may therefore fail to prevent infection or repeated injury. [8]
Foot of an 80-year old individual with type 2 diabetes and heart failure. The second toe has a large ischaemic ulcer. The first toe has a small one. The prevalence of arterial insufficiency ulcers among people with Diabetes is high due to decreased blood flow caused by the thinning of arteries and the lack of sensation due to diabetic neuropathy.
Treatment is typically to avoid the ulcer getting infected, remove any excess discharge, maintain a moist wound environment, control the edema, and ease pain caused by nerve and tissue damage. Topical antibiotics are normally used to prevent the ulcer getting infected, and the wound or ulcer is usually kept clear of dead tissue through surgical ...
The complications of diabetes can dramatically impair quality of life and cause long-lasting disability. Overall, complications are far less common and less severe in people with well-controlled blood sugar levels. [3] [4] [5] Some non-modifiable risk factors such as age at diabetes onset, type of diabetes, gender, and genetics may influence risk.
A venous ulcer tends to occur on the medial side of the leg, typically around the medial malleolus in the 'gaiter area' whereas arterial ulcer tends to occur on lateral side of the leg and over bony prominences. A venous ulcer is typically shallow with irregular sloping edges whereas an arterial ulcer can be deep and has a 'punched out' appearance.
Treatment options for PTS include proper leg elevation, compression therapy with elastic stockings, or electrostimulation devices, pharmacotherapy (pentoxifylline), herbal remedies (such as horse chestnut, rutosides), and wound care for leg ulcers. [1] [21] The benefits of compression bandages is unclear. They may be useful to treat edemas. [7]
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