In a country with an astonishing percentage of the population diagnosed with Diabetes (and probably more who have yet to be diagnosed), the demand for advanced methods to heal diabetic foot ulcers has increased. Over the last 10-20 years especially, there have been some amazing advancements in treatment modalities that focus on getting wounds healed quickly to decrease the risk of infections and amputations. The key to understanding these advanced treatment's roles is to remember that they are 'advanced.' The most important factors in healing a wound have not changed and if the 'basics' have been covered, these advanced treatment modalities are usually not needed.
Factors that must be addressed when treating a diabetic/neuropathic wound include blood flow, offloading of the area, general nutrition, blood sugar regulation, infection control and maintenance of the wound bed. If any one of these components is not addressed, the healing of the wound is delayed.
-Blood flow means making sure that pulses are present in the feet (macrovascular) and that patients who smoke are encouraged to quit (microvascular). If blood flow is not optimal, a wound may never heal as it is not able to receive the nutrients and oxygen in the blood that are required for healing. In instances where blood flow is not optimal, referral to a vascular doctor to assess for possibility of intervention may be required.
-Offloading is critical to allowing healthy tissue to grow in an area of a wound. When a wound initially forms it can be in the form of a callus or a blister. Both of these are a reflection that your foot/toe has too much pressure being placed in a given area. This causes microtrauma to the tissue and if this is not removed, the tissue cannot grow in (or if it does it is quickly disrupted). Sometimes offloading means applying a pad or making a pocket in an insert of a shoe. Other times, if the area of the ulcer is already exposed to excessive pressure, it may be recommended that you get a special boot or even use crutches a walker or a wheelchair to ensure there is no weight on the damaged area. Once a wound is healed, offloading and minimizing pressure the the previously ulcerated area is accomplished with special inserts and shoes.
-General nutrition is required to ensure that your blood contains all of the necessary nutrients to heal. General nutrition may be in question in people who do not eat a balanced diet. A simple blood test to assess albumin, a protein in the blood, can be performed to help us determine if your nutrition is part of the reason why your wound hasn't healed yet. Referral to a nutritionist can be necessary at times to increase your chances of healing.
-Regulating blood sugars is critical in wound healing. There has been a correlation seen with the time that a wound (whether a scratch, incision from surgery, or diabetic wound) and the level of the blood sugars, as reflected in a hemoglobin A1c. If you are having trouble keeping your blood sugars regulated, a visit to your primary care doctor or endocrinologist may be required.
-Infection control is very important in wound healing. If there is redness on the foot, excessive drainage or pus present when the doctor evaluates your wound, antibiotics may be recommended to decrease this drainage to allow the wound to heal.
-Maintaining a healthy wound bed is multifactorial. It is important to have regular visits to your podiatrist to have the callus and other dead tissue removed (debrided) from the wound. A "healthy" wound is one with a red base, we refer to this as granular. Fibrotic tissue can devleop over the wound bed and this must be removed and certain salves can be used to keep this from creeping into the wound. If the wound is too dry, dressings with just the right of moisture may be recommended. Similarly, if a wound is draining too much, dressings that help to keep the area dry may be recommended.
Now onto the advanced therapies! These are available in a variety of forms and in many cases these are referred to as grafts. These are materials that have been processed or engineered to either provide a scaffolding to the skin on your foot or provide growth factors to the bed of the wound that stimulate healing. These materials are derived from bovine tissue (cows), porcine tissue (pigs) and human tissue most commonly. Because of all the science that goes into developing these prodcuts, they are very pricey and insurance coverage is patchy at best. Promising results have been seen with the use of these products, but their success is still tied to how well "the basics" as described above are covered.
Save your foot by treating diabetic foot ulcers immediately! Call Prairie Path Foot & Ankle Clinic in Elmhurst to see one of our specialists today!