The Treatment of Diabetic Foot Ulcers
The most common causes of hospitalization among diabetic patient are diabetic foot problems such as ulcerations, infections and gangrene. Regular ulcer care and amputation, infection management, treatment of diabetic foot ulcers and hospitalizations require huge expenses every year and place a terrific obligation on the overall health care system. The treatment of diabetic foot ulcers is quite expensive. The average treatment expense of a single ulcer is $8000 and that of an infected ulcer is $17,000. In case if a major amputation is needed, it costs around $45,000.
Etiology
In most of the cases, people suffering from diabetic foot ulcers also experience minor trauma in the presence of sensory neuropathy. In fact, three risk factors - peripheral sensory neuropathy, deformity and trauma - are identified in over 65% of people having diabetic foot ulcers. Apart from that, few other etiological factors such as calluses, edema and peripheral vascular disease have been also identified contributing to the formation of diabetic foot ulcers.
An effective treatment of diabetic foot ulcers comprises of dealing with these three fundamental concerns - debridement, offloading and infection control.
Debridement
Debridement comprises of elimination of all neurotic tissue, pre-wound callus, and exotic bodies down to functional tissue. Appropriate debridement treatment of diabetic foot ulcers is essential to minimize the risk of infection and decrease pre-wound pressure. Otherwise it may lead to an obstruction to normal wound contraction and to the overall healing process. In the post-debridement phase, the wound is washed with saline or cleanser and then a proper dressing should be administered.
Offloading
The most successful method of offloading treatment of diabetic foot ulcers is to completely hold the body weight with the help of a wheelchair or crutches. Total contact casts (TCC) is the integral part of offloading method. Although TCC is quite complex, time consuming and expensive, it significantly decreases wounds' pressure and have been revealed to treat between 73% and 100% of all wounds healed by using this method.
Improper administration of TCC may cause new ulcers. Additionally, it may also result deep or draining wounds and may turn out to be complicated for people suffering from morbid obesity and severe vascular complications.
Infection Control
The nature of infections occurring in diabetic foot ulcers is typically poly-microbial. In general, methicillin-resistant staphylococcus aureus, enterobacteriaceae, pseudomonas aeruginosa, b-hemolytic streptococci, and enterococci are the most commonly found pathogens. Although rare, the aerobes mixed infection may also occur. In such cases, the common pathogens are bacteroides, peptococcus and peptostreptococcus.
Antibiotic interventions are the primary line of treatment of diabetic foot ulcers' infection. Patients having severe infections are typically hospitalized and they are treated with intravenous antibiotics. However, mild to moderate infection can be treated using orally administered antibiotics.
