Diabetic Foot Ulcers Treatment

This line has been borrowed from a very experienced diabetic foot expert podiatrist in the USA and it couldn’t be more accurate.

For many people, having a diabetic foot ulcer is terrifying, particularly if it’s the 2nd or 3rd time and the previous times have to lead to amputation.

The angst to use the best most perfect dressing (putting something on) can be difficult particularly if there are many team members saying different things.

Maybe the wound nurse wants flaminal (a gel-like dressing) but the wound consultant says a silver dressing is needed. Then there is the advice from a forum saying Manuka honey works best but all you have is betadine. 

Help. What do you put on?

If you really want to give your diabetic foot ulcer the best chance to heal, it’s what you take off the wound.

To give it the best chance to heal in the fastest possible time frame you must take off: 

• Pressure - this can be done by padding, using orthotics, CAM Walkers or appropriate footwear to reduce pressure.
• Non-viable tissue - your podiatrist is skilled in sharp debridement and wound care which is the precise usage of instruments to remove non-viable tissue such as callus, hyper granulation tissue, eschar and much more. Seeing your podiatrist regularly for this is imperative.
• Excess moisture and any bacterial overgrowth (think pus) - moisture and bacterial overgrowth can be taken away by choosing appropriate dressing time frames (daily, 2nd daily, once per week, etc.) and deciding when and where to use antimicrobial dressings and antibiotics.

Shoes can greatly increase or decrease pressure at a wound site, which can have one of the biggest influences on wound healing. 

Sometimes, the shoe needed is a CAM walker (‘moon boot’) - the absolute grand-daddy of pressure care devices.

CAM Walkers can be padded up with mountains of felt to offload a wound site and have stubborn months old ulcers healing up in weeks.

Shoes can be used to maintain recently healed diabetic foot ulcers as well.

Uppers made from soft and flexible materials, such as neoprene, are vital in healing and maintaining ulcer-free feet.

Everyone with diabetes is automatically at a higher risk level of developing a foot ulcer vs. someone otherwise evenly matched but without diabetes.

Within this level of higher risk, there are further levels as well. Confused? Let me explain.

1. Someone with diabetes that is well-controlled with good circulation and sensation, no foot deformities present and no pressure lesions, such as corns and calluses, is considered at low risk of ulceration and amputation.

   Here, an annual visit to a podiatrist for a Foot Risk Assessment might be all they need to do alongside some quality self-care at home.

2. The next person who has diminished circulation or develops corns and callus pressure lesions are automatically at a moderate risk level.

   Here, more regular visits to a podiatrist are required to have those lesions attended to and prevented with appropriate footwear or custom foot orthotics.

   If you’re in this moderate risk category, be more vigilant at home with your self-care - washing, drying and moisturising becomes even more important.

3. If you have severe circulation problems or a lack of protective sensation, you’re at a high risk of ulceration and amputation.

   In this case, the nerves lose their ability to send messages upstairs and potentially painful stimulus, like blisters, lesions, blocks of lego, are missed and cause damage.

   If this happens and there’s not enough blood circulating down there, re-vascularization via surgeon or amputation are very real and scary pathways to be staring down.

   If you’re in the high-risk category, it’s vital to attend regular neurovascular assessments, primary care, footwear, orthotics and appropriate exercise therapies with your podiatrist.

If you don’t know your risk level, book in with our podiatrists to find out. You can make an appointment online here at any of our podiatry clinics in Melbourne, Pascoe Vale or Emerald.