Nonsurgical Treatment For Diabetic Foot Ulcers
To help a diabetic foot ulcer heal, doctors at NYU Langone clean and disinfect the area. If the ulcer is infected, your doctor prescribes antibiotics to clear it up and prevent it from traveling to a bone in the foot.
Your doctor can refer you to an NYU Langone vascular specialist for additional medication if you have lower extremity arterial disease, a condition that impairs blood flow to the legs and feet and can cause an ulcer to heal more slowly.
NYU Langone doctors recommend regular wound care for foot ulcers, as well as other therapies.
How Can A Foot Ulcer Be Prevented
The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing a podiatrist on a regular basis. He or she can determine if you are at high risk for developing a foot ulcer and implement strategies for prevention.
You are at high risk if you:
- Have neuropathy
- Have a foot deformity
- Wear inappropriate shoes
- Have uncontrolled blood sugar
Reducing additional risk factors, such as smoking, drinking alcohol, high cholesterol, and elevated blood glucose are important in the prevention and treatment of a diabetic foot ulcer. Wearing the appropriate shoes and socks will go a long way in reducing risks. Your podiatric physician can provide guidance in selecting the proper shoes.
Learning how to check your feet is crucial in noticing a potential problem as early as possible. Inspect your feet every dayespecially between the toes and the solefor cuts, bruises, cracks, blisters, redness, ulcers, and any sign of abnormality. Each time you visit a health care provider, remove your shoes and socks so your feet can be examined. Any problems that are discovered should be reported to your podiatrist or a medical professional as soon as possible, no matter how simple it may seem to you.
The key to successful wound healing is regular podiatric medical care to ensure the following gold standard of care:
- Lowering blood sugar
What Is Diabetic Foot Ulcer
Anyone with diabetes is at a high risk of developing foot ulcers. These ulcers are commonly found below the big toe, or balls of your feet. They are caused due to skin breakdown exposing the layers underneath and sometimes can affect the feet down to the bones. If not cared for foot ulcers can even result in amputations. People with diabetes must take good care of their feet. Do not ignore early signs of infection and skin breakdown and discuss every issue with your doctor to avoid serious issues.
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Also Follow These Tips To Ensure The Fast Healing Of The Diabetic Foot Ulcers:
- Foods enriched in zinc help in keeping blood sugar level in control. Zinc also promotes fast healing of the body tissues. Thus, you must have eggs, legumes, and nuts on a regular basis.
- Flaxseed oil is an amazing remedy for diabetic foot ulcers. It is rich in omega 3 fats that are very essential for a healthy vascular system. Therefore, it hastens the process of healing of diabetic foot ulcers.
- Vitamin E prevents the infection from growing in a diabetic foot ulcer. So, you should have avocados, capsicum, and nuts regularly.
- Coffee is excellent for improving the blood flow to the foot. The enhanced blood flow triggers the bodys immune response to fight the infection in the foot ulcers and heal them fast.
Preventing Diabetic Foot Ulcers
There are several ways to prevent a foot ulcer. In addition to daily checks of your feet for any signs of an ulcer or other abnormality, the following can be done to help with prevention:
- Never walk barefoot, and always wear socks to protect your feet
- Wear shoes that fit properly and do not rub
- Keep your blood sugar under control and monitored
- Eat a healthy diet
- Avoid alcohol and tobacco products
- Seek immediate medical attention if you have a foot wound that is not healing
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How To Apply Diabetic Foot Cream
Each foot cream comes with its own how to apply instructions. As a common rule, it is generally recommended to apply diabetic foot cream on clean and dry feet. Remember that when living with diabetes, it is important to gently wash your feet daily and to carefully dry them.
Once your feet are clean and dry, apply your cream or lotion and gently massage your feet insisting on the dry or painful areas. Avoid the in-between toe areas: its better to keep it a bit dryer to avoid fungal infections.
How Can I Prevent Or Reduce My Risk Of Foot And Toe Ulcers
It may be possible to reduce your risk of getting ulcers, and even stop them from coming back. Try to:
- Manage your diabetes. If you have diabetes you should wear appropriate footwear and never walk barefoot.
- Every day, examine your legs as well as the tops and bottoms of your feet and the areas between your toes. Look for any blisters, cuts, cracks, scratches or other sores. Also check for redness, increased warmth, ingrown toenails, corns and calluses. Use a mirror to view your leg or foot if necessary, or have a family member look at the area for you. See a healthcare provider immediately if you notice any problems.
- Wear appropriate shoes and socks. Talk to your podiatrist about what you need.
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Anhydrous Ointment For Diabetic Foot Ulcer
Loyd V. Allen, Jr., PhDProfessor EmeritusCollege of Pharmacy, University of OklahomaOklahoma City
US Pharm. 2018 43:59-60.
Method of Preparation: Calculate the quantity of each ingredient for the amount to be prepared. Accurately weigh or measure each ingredient. Reduce the powders to a relatively uniform particle size and mix together. Incorporate the Aquaphor geometrically, with thorough mixing after each addition. Package and label.
Use: This preparation has been used in the treatment of foot ulcers resulting from diabetes.
Packaging: Package in a tight, light-resistant container.
Labeling: Keep out of reach of children. Discard after ____ . Protect from light. For external use only.
Stability: A beyond-use date of up to 6 months may be used for this preparation.1
Quality Control: Quality-control assessment can include theoretical weight compared with actual weight, specific gravity, active drug assay, color, texturesurface, texturespatula spread, appearance, feel, rheologic properties, and physical observations.2
Clotrimazole occurs as a white to pale-yellow, crystalline powder that melts at about 142°C with decomposition. It is freely soluble in alcohol and practically insoluble in water. Clotrimazole is an antifungal agent used topically and vaginally in the treatment of susceptible fungal infections.1,3
How The Intervention Might Work
For millennia healers have applied various compounds to infected wounds, some of which are still in use today. Use of a topical application has many potential advantages compared with giving systemic antibiotic therapy, including: a high and sustained concentration of the antimicrobial agent at the site of infection the need to use only a limited amount of the antimicrobial at the selected site avoidance of potential toxicity associated with systemic treatment ability to use novel agents not available for systemic use easy application in the outpatient setting and potentially better patient adherence to treatment. Topical treatments may also prove helpful in addressing the globally increasing problem of multidrugresistant organisms that are now untreatable with most systemic agents. For example, a study of 47 organisms from burn wounds that were multidrugresistant to systemic antibiotics were susceptible to 11 commonly used topical antibiotics and antiseptics, although the rates of resistance were higher than in nonmultidrugresistant organisms .
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What’s The Difference Between Regular Skin Lotion And Diabetic Lotion
To be honest: diabetic lotions and diabetic creams dont exist! There is no such thing as a diabetic skincare product that cures all diabetes-related skin problems. Putting the word diabetic on a foot cream packaging is simply an efficient marketing strategy to sell at a higher price. That being said, foot creams and lotions that are labeled for diabetics usually share common diabetes-friendly features.
When you live with diabetes, and even more so with peripheral neuropathy, you want to make sure the lotion youre applying does not do you more harm than good. Thats what diabetic foot creams are about. First, all creams and lotions for diabetics are good moisturizers. Second, a good diabetic cream should not be irritating . Third, it should not be too greasy. Fourth, your diabetic lotions should be soothing to help alleviate common skin irritations, itchiness, and other unpleasantnesses.
If you suffer from peripheral neuropathy foot pain, you can also look for a foot cream with pain-relieving ingredients.
Medical Grade Honey Ointment
Honey is a well-known alternative dressing for diabetic foot wounds. Honey has anti-inflammatory, antiseptic and antibiotic effects that help subside the pain and itching of the diabetic foot ulcer. The topical usage of honey also creates a low pH environment and thus promotes the growth of new tissues and faster healing. The numerous benefits of honey as a dressing have led to the development of medical-grade honey ointments like Manuka, First Honey, etc.
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Identifying Symptoms And Diagnosis
One of the first signs of a foot ulcer is drainage from your foot that might stain your socks or leak out in your shoe. Unusual swelling, irritation, redness, and odors from one or both feet are also common early symptoms.
The most visible sign of a serious foot ulcer is black tissue surrounding the ulcer. This forms because of an absence of healthy blood flow to the area around the ulcer.
Partial or complete gangrene, which refers to tissue death due to infections, can appear around the ulcer. In this case, odorous discharge, pain, and numbness can occur.
Signs of foot ulcers are not always obvious. Sometimes, you wont even show symptoms of ulcers until the ulcer has become infected.
Talk with your doctor if you begin to see any skin discoloration, especially tissue that has turned black, or feel any pain around an area that appears callused or irritated.
Your doctor will likely identify the seriousness of your 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
Ulcers in people with diabetes are most commonly caused by:
- poor circulation
- nerve damage
- irritated or wounded feet
Infection of a foot ulcer can be prevented with:
Structured Diabetic Foot Care
Stem and progenitor cell-based topical treatments will not be used in isolation to treat diabetic foot ulceration. Ideally, these advanced biological treatments will be part of a treatment algorithm, which would see the implementation of standard care prior to use of cell therapy. If the restoration of vascular supply, removal of pressure, control of infection and debridement of the wound does not succeed in ulcer healing, then the indication for cell based therapy would apply. There are analyses of factors associated with lack of healing with fibroblast dermal substitutes. An episode of infection during 12 weeks of treatment was associated with a 3.4 times increased risk of non-closure of a wound. High bacterial load in the wound negatively affects wound healing with Dermagraft and Browne et al. recommend reducing the bacterial load with combination antibiotics prior to the application of skin substitutes. New treatment modalities are under investigation which may augment wound healing and reduce bacterial load. Plasma therapy may reduce bacterial burden and enhance wound healing.
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Impaired Angiogenesis In Diabetes Due To Epc Dysfunction
It is known that EPCs are decreased in number and dysfunctional in people suffering from diabetes mellitus. The decrease in number of circulating EPCs in people with diabetes is still under investigation but defects in the SDF-1/CXCR-4 pathway are becoming evident. There are defects in EPC recruitment to wound sites. This is due to decreased mobilisation from the bone marrow and decreased homing to cutaneous wounds. With diabetes there is decreased EPC participation in neoangiogenesis and neovsacularisation. Studies show that there are defects in cell migration, adhesion and tube formation. There is also an increase in reactive oxygen species in EPCs isolated from diabetes patients leading to cellular dysfunction. There is a body of evidence indicating that diabetes mellitus related EPC cell dysfunction represents a mechanism for impaired angiogenesis and impaired wound healing seen in diabetic patients. The obstacle with autologus EPC therapy for diabetic complications is that there is a decreased number of cells available for transplantation. In addition, these autologous cells are dysfunctional.
Effectively Dressing Diabetic Foot Ulcers
Creating an optimal environment is essential to ensuring rapid healing and preventing complications. However, it can be challenging to effectively dress wounds located on the foot, particularly in cases of deformity or disease such as Charcot foot. To dress these wounds appropriately, health care professionals must often use non-traditional methods. Using best practices and more effective medical adhesive products can allow dressings to stay secure longer, even in unusual locations.2,4
Infection Control Infection in DFUs can lead to inflammation, delayed wound healing, gangrene, and amputation. To reduce the risk of infection and improve outcomes, health care professionals can use dressings that control bacterial load in the wound. Antibacterial agents such metronidazole gel and sisomicin can help control pathogens in the wound area.5
Wound Protection Because DFUs are located on the foot, they are more susceptible to additional injury than wounds in a less exposed location. This makes it important to choose a dressing that provides some amount of mechanical protection. Dressings that are secure and substantial can protect the wound area from additional damage. Using offloading techniques such as total contact casts and removable cast footwear can also help provide support the foot and prevent repetitive trauma.5
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Treatment Options For Foot Ulcers
A DFW wound care doctor can examine your feet, check for signs of infection, and recommend treatment options for your diabetic foot ulcer based on your specific condition and needs. For foot ulcers that are severely infected or spreading to other areas, hospitalization may be needed.
According to our DFW wound care doctor, some of the most common treatments for a foot ulcer are:
- Off-loading.Off-loading is recommended to take pressure off the ulcer. This can be done by using padding over the ulcer, crutches while walking, a brace or cast on the foot, or a compression wrap.
- Medication. If there are signs of an infection, an antibiotic ointment can be put on the ulcer then covered with a dressing or bandage. An oral antibiotic may also be prescribed to help with infection.
- Cleaning. The ulcer should be kept clean and dry. This can be done by washing the ulcer daily with a mild soap and warm water and changing any dressings or bandages used to cover the ulcer.
- Debridement. Removing any dead skin or tissue by debridement is often done to speed up the healing process. Debridement is done by a podiatrist using a sharp tool to remove the skin and tissue.
- Surgery. If more conservative foot ulcer treatments have not been successful, surgery may be recommended. Surgery can be done to correct a foot deformity such as a hammertoe or bunion that is causing the foot ulcer. Also, shaving or removing bones is an alternative option.
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How To Treat Ulcers
If you do get an ulcer or notice a change in your skin that youâre not sure about, tell your doctor right away. Youâll likely get a procedure called debridement, which removes unhealthy tissue from the wound to spur healing.
Your doctor will also work with you to try to keep your sore or ulcer from getting infected and becoming bigger. Some of the steps they may recommend include:
Clean your ulcer daily. Use soap and water, unless your doctor recommends another cleanser. Donât use hydrogen peroxide or soak your wound in a bath or whirlpool, because this could reduce healing and may boost your odds of infection.
Keep your ulcer bandaged or covered with a wound dressing. While you may have heard that itâs important to âair outâ wounds, experts now know that not covering a wound actually increases the odds of infection and slows healing.
Keep pressure off your ulcer, especially if itâs on your foot. This may mean you need to use crutches, special footwear, a brace, or other devices. Reducing pressure and irritation helps ulcers heal faster.
Use the topical medications your doctor recommends. These may be saline, growth factors, and/or skin substitutes.
Keep your blood sugar under control. In addition to reducing your risk of ulcers, tight blood sugar control helps your body heal existing ulcers.