Diabetes is a growing concern ...
I am sure all of us would know diabetes is all about the uncontrolled sugar in our body. We know that diet and lifestyle contribute a huge part to the development of the disease.
But, little are aware of its severe complications. In the lifespan of a diabetic patient, 15% to 25% would be expected to suffer from non-healing wounds especially at the lower extremities. The non-healing wounds are known as diabetic foot ulcers which are the most common foot injuries leading to amputations.
Diabetic foot ulcers are defined as the bacterial infection, ulceration or tissue death situated at the foot that is commonly associated to people with diabetes.
Figure 1: The picture shows the ulcer development at the toe and the sole of the feet
Sourced from https://www.wmar2news.com/news/health/gbmc/diabetic-foot-ulcers-left-untreated-can-lead-ot-amputation
Diabetic foot ulcers have gained a lot of attention in recent years. With the non-stop rising of diabetes prevalence, more and more people are experiencing the serious side effects of diabetes which is the diabetic foot ulcers. The non-healing wound posed a great concern to the healthcare system due to the high mortality and complexity in wound care. A research done by Robbins et al in 2008, patients who had to undergo amputations due to diabetic foot ulcers had a 48% 5-year mortality rate compared to those who did not undergo amputation.
The formation of Diabetic Foot Ulcers can be due to a combination of factors such as
Poor blood circulation - The blood unable to reach to your feet can cause the ulcers to heal much slower.
Damaged nerves - The numbness and loss of feelings due to the damaged nerves can lead to the formation of painless wounds then cause ulcers.
Irritated and non-healing wound- Ulcers appear with pus at the wound or as a lump
High blood sugar (hyperglycemia) - Hyperglycemia can slow down wound healing, it is important to control blood sugar level
These factors mentioned are usually preceded by the diabetes condition itself.
Figure 2: Diabetic foot ulcers being staged as sourced from https://www.diabetestreatmentguide.org/how-to-control-diabetic-ulcers-in-five-steps/
The wounds can be classified by your doctors into a few groups for the purpose of targeted treatment. The classification is based on the condition of your foot looking into:
Presence of ulcers
Presence of infection
Presence of tissue death
Depth of the affected wound
Table 1: University Texas Classification is preferred classification system by Ministry of Health Malaysia.
Prevention is always far better than treatment. Here are effective strategies to prevent Diabetic Foot Ulcers:
Annual foot examination - It is recommended to do it at least annually and more frequent for higher risk patients.
Control over diabetic condition - A good control of glucose level can help in preventing the diabetic foot ulcer
Appropriate footwear - Make sure to wear proper footwear in order to prevent unnecessary wounds
Preventive surgeries - Orthopaedic surgeons will consider the history of ulceration and the risk of re-ulceration of diabetic patients before undergoing surgery
Non-surgical such as antibiotic treatment, wound management, rehabilitation and other alternative treatment can to treat the infection and improve wound healing progress
Surgical such as debridement process, tissue reconstruction process and revascularization procedures can be done to the site of wound
Amputation and post-amputation management
The care of diabetic wounds are often complex and usually long term treatment is required in order to promote complete wound healing. Hence, it is best to adapt to a healthy lifestyle in order to prevent the diabetes.
Read more about diabetes-related article over here
Robbins, J. M., Strauss, G., Aron, D., Long, J., Kuba, J., & Kaplan, Y. (2008). Mortality Rates and Diabetic Foot Ulcers. Journal of the American Podiatric Medical Association, 98(6), 489–493. https://doi.org/10.7547/0980489
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