People with diabetes develop foot ulcers because of neuropathy (nerve problems), ischaemia (circulation problems) or both. The initial start may be from some trauma to the foot or even from burns or from repetitively or continuously applied mechanical stress to the foot.
Other complications contributing to the onset of ulceration include poor vision, limited joint mobility, and the consequences of cardiovascular and cerebrovascular disease. However, the most common cause is accidental trauma, especially from wearing ill-fitting footwear.
Once the skin is broken, many processes contribute to defective healing, including bacterial infection, tissue ischaemia, continuing trauma, and poor management.
Diabetic foot ulcers are usually painless, punched-out ulcers in areas of thick callus, sometimes with superadded infection, pus, oedema, erythema, crepitus, malodour.
Management of the diabetic foot includes educating patients about the disease and how to prevent such complications. Education also involves how to identify early signs and what should be done. The management also includes the importance of routine preventative podiatry care, and appropriate footwear. The person should check their feet every day and report any sores or cuts that do not heal, puffiness, swelling, and skin that feels hot to the touch.
Control of glucose, blood pressure and cholesterol; smoking cessation and weight control are also important. Antibiotics should be used to manage and prevent infection. Wound management, including keeping the wound dry and debridement of dead tissue should be done regularly.
Foot ulcers in people with diabetes have a high risk of necessitating amputation and so everything should be done to prevent amputation. Ulcer recurrence rates are high, but appropriate education for patients, regular surveillance, the provision of post-healing footwear and regular foot care can reduce rates of re-ulceration.
Early detection and effective management of diabetic foot ulcers can reduce complications, including preventable amputations and possible mortality. Even when healed, diabetic foot should be regarded as a lifelong condition and treated accordingly to prevent recurrence.
Dr Rosmond Adams, MD is a medical doctor and a public health specialist with training in bioethics and ethical issues in medicine, the life sciences and research. He is the head of Health Information, Communicable Diseases and Emergency Response at the Caribbean Public Health Agency (CARPHA). (The views expressed here are not written on behalf of CARPHA).
Dr Rosmond Adams is a medical doctor and a public health specialist. He may be emailed at:adamsrosmond@gmail.com
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