Diabetic ulcers are the most common foot injuries seen in patients with diabetes. An ulcer is an area on the skin where the skin has broken down and you can see the underlying tissue.
Whenever there is an injury or a cut, the skin normally heals quickly; however, in diabetics, it does not heal very well and is prone to formation of an ulcer which can occur even after a mild injury.
Approximately 15% of all patients with diabetes will develop a foot ulceration at some point during the course of their disease, and of those patients who develop a foot ulcer, 15% to 20% of them will lose a limb to amputation.
Diabetic Ulcer Cause
Foot ulcers are complication of uncontrolled diabetes. There is damage to the nerves of diabetics; and some patients with diabetes cannot feel the bottom of their feet. If the sensation in your foot is lost or reduced, you may not feel if you damage your feet.
For example, if you tread on something sharp or develop a blister due to a tight shoe, it may go unnoticed. You may not feel pain and therefore you do not even protect these small wounds which can quickly become worse and develop into ulcers.
Secondly, your blood vessels (like arteries) also narrow in patients with diabetes. This is due to fatty deposits called atheroma that build up on the inside lining of arteries which can reduce the blood supply to various organs of the body.
The arteries in the legs are quite commonly affected, and because of reduced blood supply, the wound does not heal like it should and is more likely to be damaged.
Foot ulcers are a serious concern in diabetics because they can take a long time to heal. You are also more likely to have infections in the ulcer. Occasionally, more serious problems can develop, such as gangrene.
Risk factors for developing foot ulcers include age, male gender, races like African American, Hispanic Americans, and native Americans.
The longer you have diabetes, the greater the risk of developing a diabetic foot ulcer. Smoking is also a significant risk factor for developing ulcers in diabetics.
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Diabetic Ulcer Symptoms
Before you would notice a ulcer on the foot, there would be reddening of the skin, blistering, and other signs of irritation. Later, you may notice an open wound that drains fluid onto your socks or bedding while sleeping.
The open wound can then become infected and develop swelling, redness, and drainage of pus. There also can be pain at the site of ulcer. You may run a high temperature. Your blood sugar levels may also be elevated.
You should call your doctor right away even if there is a minor injury to the foot or persistent mild-to-moderate pain in the feet, if you notice new blisters, wounds or ulcers that appear, and if there is new or constant numbness in the foot.
If you develop a constant itching of the skin you should also see your doctor.
Diabetic Ulcer Treatment
Regular health checks and monitoring of blood glucose levels is very important if you are a diabetic. Monitoring includes regular measurement of oxygen levels in the skin, blood flow in the veins of the legs, and pulses in the legs and feet.
If you smoke, you need to quit smoking.
A diet for diabetes should be carefully followed for blood sugar control.
Getting a blood pressure reading should be done regularly, and cholesterol levels can and should be assessed. Certain medications can control any issues associated with these conditions.
It is necessary for diabetics to do regular exercising to improve circulation to the feet.
If there is any sign of skin damage, the treatment may consist of local wound care and antibiotics. Infections, especially those that have reached the bone, must be treated surgically. Applying pressure on the ulcer should be avoided during its healing period because the new tissue is extremely delicate.
The wound is treated with compression of the leg to minimize swelling. Compression treatments include moist to moist dressings, hydrogels, alginate dressings, collagen wound dressings, debriding agents, antimicrobial dressings, and composite dressings.
Hyperbaric oxygen therapy is also used for treating diabetic ulcers where the patient is exposed to 100% oxygen and 2 to 3 times the normal atmospheric pressure. It increases the saturation of oxygen in the blood while promoting tissue development.
PRP Treatment for Diabetic Ulcer
As we have learned, uncontrolled diabetes has many complications. Complications include having decreased sensation in the limbs and a decreased blood supply (ischaemia) to the limbs. Diabetic patients with ischaemic foot ulcers have the worst outcome of all chronic skin wounds.
Surgery to heal diabetic ulcers can include tenotomy, tendon lengthening, reconstruction surgery, or removal of bony prominences of the foot, but these procedures may result in a secondary ulceration. Also, along with secondary ulceration, some other complications may also arise. The recurrence rate for diabetic ulcers is also very high.
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In recent years, to combat these issues, medical science has introduced topical gels containing growth factors that is proving to be a successful form of treatment for diabetic ulcers.
Platelet rich plasma (PRP) gel is an efficacious treatment of chronic diabetic foot ulceration. It represents similarity to the natural healing process as a composite of multiple growth factors. It is safe due to its autologous nature (derived from same person).
Growth factors are proteins that play an important role in wound healing. Without functional growth factors, an ulcer can get stuck in a non-healing phase and will be very difficult to heal on it’s own.
There have been many studies conducted on the efficacy and safety of using platelet rich plasma over the years to treat diabetic foot ulcers, and most of them have concluded that the patients had complete healing. The procedure is safe and there are no serious adverse effects of this therapy.
If diabetic foot ulcers are left untreated or treated inappropriately or treated late, gangrene (death of the tissue) may result and you may have to sacrifice your limb. PRP gel therapy provides ulcer management option to avoid loss of limb.
When used with good standards of care, the majority of non healing diabetic foot ulcers treated with autologous platelet-rich plasma gel are expected to heal.
Platelets contain a large numbers of different types of growth factors. When applied topically on the ulcer, this preparation promotes rapid vascularization of the healing tissue and, because it is autologous, it eliminates concerns about immunogenic reactions and disease transmission.
Approximately ≤ 20 ml of blood is collected from the patient depending on the size of the ulcer and is placed in a centrifuge for 15 minutes. A centrifuge spins the blood to separate the platelets.
The platelet concentrate is then mixed with a reagent (thrombin) to create a gel-like substance which is applied directly to the wound. Gel consistency is usually attained within 15 to 30 seconds after mixing with the reagent. A contact layer dressing will then be applied over the gel.
A foam dressing is then placed over the contact dressing so that PRP gel is not absorbed. To protect it from slipping out, a barrier cream is generally placed on the intact skin surrounding the wound.
There is no fear of infection or immunologic reactions. The results are generally evident in as little as 5 weeks if given twice weekly.
Each visit, the wound is cleaned and assessed for improvement. Several studies have shown that withdrawal of small amount of blood twice weekly does not affect patient’s hemoglobin levels.
Cost of PRP Treatment for Diabetic Ulcer
Foot ulcers are an expensive problem. A healed ulcer greatly improves the poor quality of life caused by a foot ulcer, whereas a non healing ulcer reduces the quality of life for both patients and his/her caregiver.
Cost of amputation is high which involves the surgery cost and cost of hospitalization stay. In addition, the patient has to take off from work and this contributes to loss of pay. All coupled together, this is a significant cost to the patient.
PRP therapy, on the other hand, can be applied in an outpatient or clinic medical setting which represents cost effectiveness for patients. Several studies have concluded the use of PRP gel results in improved quality of life and lowered cost of care as compared to other treatment modalities for nonhealing diabetic foot ulcers.
PRP is not a expensive technique and has rapid healing capacity. Currently there is no insurance cover, but the cost of treating a patient with PRP is significantly lower.
- How will this treatment help treat the ulcer?
- How long will this treatment take?
- Do I have to come for follow ups regularly?
- Is there a chance of recurrence of ulcer after this treatment?
- Is the treatment painful?
- How much will the therapy cost?
- Is it covered by insurance?
Diabetic Ulcer Prevention
Wearing shoes that fit properly, and regular inspection of the feet helps in reducing the risk of having a diabetic foot ulcer. Good foot hygiene is crucial. There are diabetic shoes available on the market today for all sizes. Don’t ignore leg pain and never try to trim calluses or corns yourself.
Diabetic Ulcer Complications
If left untreated, the ulcer may get infected which may increase and spread to the body. There will be loss of function and ability to perform daily activities. Amputation of involved foot or leg may be required in later stages due to gangrene.
After one limb has been amputated, the opposite limb is often lost within a few years because of the ongoing problems and vascular disease; also the opposite leg has to bear increased pressure and workload.
Questions you should ask your doctor about Diabetic Ulcer
- What is diabetic foot ulcer?
- What are common problems that may lead to a diabetic foot ulcer?
- What tests may I have to undergo when I have a diabetic foot ulcer?
- Is this treatable?
- How would you treat it?
- Do I have to be on bedridden until it is healed?
- What medications will I have to take?
- Will I need to alter my diet during the healing process?
- How can I prevent it occurring on my other foot?
- What more can I do to control my diabetes?
- How can special shoes help my feet?
- How can diabetes harm my skin?
- Have there been any recent advancement’s in treatment for the diabetic foot?