Diabetic foot ulcers happen as an outcome of various factors, such as mechanical changes in conformation of the bony architecture of the foot, peripheral neuropathy, and atherosclerotic peripheral arterial disease, all which occur with higher frequency and intensity in the diabetic population.
Nonenzymatic glycation inclines ligaments to stiffness. Neuropathy causes loss of protective feeling and loss of coordination of muscle groups in the foot and leg, both which increase mechanical tensions during ambulation.
Diabetic foot lesions are accountable for more hospitalizations than other problem of diabetes. Diabetes is the leading cause of nontraumatic lower extremity amputations in the United States, with around 5% of diabetics establishing foot ulcers each year and 1% requiring amputation.
Physical examination of the extremity having a diabetic ulcer can be divided into examination of the ulcer and the basic condition of the extremity, assessment of the possibility of vascular deficiency, and assessment for the possibility of peripheral neuropathy.
The staging of diabetic foot injuries is based on the depth of soft tissue and osseous participation. A total blood cell count ought to be done, in addition to evaluation of serum glucose, glycohemoglobin, and creatinine levels.
The management of diabetic foot ulcers needs unloading the wound by using proper restorative footwear, daily saline or similar dressings to supply a moist injury environment, debridement when required, antibiotic therapy if osteomyelitis or cellulitis is present, optimum control of blood glucose, and evaluation and correction of peripheral arterial deficiency.
A vascular surgeon and/or podiatric surgeon must evaluate all patients with diabetic foot ulcers so regarding identify the requirement for debridement, revisional surgery on bony architecture, vascular restoration, or soft tissue protection.
The hemorrheologic agent cilostazol is contraindicated in patients with congestive heart failure. See Medication regarding the product’s black box caution.
Also read: Foot Complications (Diabetic Foot)