Diabetic foot

As a result of the loss of insulin production, and the potential for poorly controlled blood sugars, a diabetic can develop vascular and neurological damage which manifests in the feet as the Neuropathic Ischaemic foot.

There are different levels of diabetes, Type 1 diabetics need to be controlled with injectible insulin, Type 2 diabetics may need pills or adjusted diets to assist them.

The diabetic needs to take special care of their feet as the risk factors are so much higher. Daily visual examination of the toenails and for sites of skin damage or pressure sites should be part a routine as a diabetic may not always have good sensation on their feet and feel the pain that would send most people running to the Doctor.

So due to nerve and circulatory damage the reaction to pain may be delayed and late, leaving a more severe problem that may also be slow in healing.

The most common diabetic foot is the Neuropathic foot, and it manifests as a loss of peripheral sensation. If one has an ingrown toenail, you may not feel it even though an infection could be brewing. Due to the loss of pressure sensation a callus under the foot can build to the point of breakdown leading to ulceration. A diabetic ulcer can be very stubborn to heal, as the circulation to the area is already poor and the cellular oxygen levels are low. This type of environment does not assist healing, and should an infection occur, the wound may become gangrenous and amputation may be required.

The Ischaemic foot is a very sensitive foot as the peripherals of the foot may be super sensitive to the touch. The toes and borders of the foot may be red, and the skin paper thin.

Pressure on this foot may lead to breakdown on the periphery of the foot and ulcers may form. The ends of the toes and borders of the foot are susceptible.

A diabetic does not necessarily have to fear, when they control their diets, they can be even healthier than the average person. But should they fail to do so, the risks increase. A blood sugar that is not kept below 8mm, run the risk of peripheral nerve and circulatory damage.

Treatment of the diabetic ulcer can take some time and patience. It requires attention to the cause of the pressure and the use of insoles or orthotics to assist in pressure re-distribution.

The orthotics often have to be soft and cushioning with pressure relieving “cut outs” over the ulcer site. Without pressure relief, the ulcer cannot start to heal due to repetitive trauma to the site when walking.

Then the wound is debrided to remove callus and necrotic tissue to allow the wound to heal.

There are numerous specialised dressings on the market, and a choice is made as to what would be appropriate.
A de-sloughing or de-briding gel can be used to lift off old cells and reveal new granulating cells.

Then anti-septic creams to reduce the incidence of infection.