Decoding the diabetic foot ulcer
Understanding, managing, and preventing a serious complication

Dr Mackson Nongmaithem *

Diabetes mellitus, a chronic condition affecting millions worldwide, brings numerous complications—one of the most serious being the diabetic foot ulcer (DFU). These open wounds affect about 15% of people with diabetes and are becoming increasingly common in Manipur. Understanding their causes, progression, management, and especially prevention isessential for patients, families, and healthcare providers.

The Roots: Causes and Mechanisms

DFUs usually result from a combination of factors. Diabetic neuropathy—nerve damage from prolonged high blood sugar—leads to reduced foot sensation, so minor injuries often go unnoticed. Peripheral artery disease (PAD), which narrows blood vessels and reduces circulation, further delays healing.

Additional risk actors include:

o Foot deformities
o Limited joint mobility
o History of ulcers or amputations
o Poor blood sugar control

A DFU typically starts with skin injury. In people without diabetes, such wounds heal normally. But in diabetics, neuropathy and poor circulation impair healing and increase infection risk, sometimes leading to serious complications like tissue damage or amputation.

Investigations:

A thorough evaluation is crucial for effective DFU management. This typically involves:

o Clinical examination: A detailed assessment of the wound's size, depth, location, and presence of infection. Examination of the skin, nails, and foot structure is also vital.
o Neurological assessment: Tests to evaluate sensation, reflexes, and vibration perception to determine the extent of neuropathy.
o Vascular assessment: Evaluation of blood flow using methods like palpation of pulses, Doppler ultrasound, and ankle-brachial index (ABI) to identify PAD.
o Wound culture: If infection is suspected, a sample of the wound drainage is sent for laboratory analysis to identify the specific bacteria and guide antibiotic treatment.
o Radiological imaging: X-rays may be necessary to assess for osteomyelitis (bone infection) or underlying bone deformities. T% Blood tests: To monitor blood glucose levels, inflammatory markers, and overall health status.

A Multifaceted Approach: Treatment Strategies

Managing a DFU requires a comprehensive and multidisciplinary approach involving doctors, nurses, podiatrists, and sometimes vascular surgeons and infectious disease specialists.

Key treatment strategies include:

o Debridement: Removing dead or infected tissue to support healing.
o Offloading: Relieving pressure on the ulcer using special footwear, casts, or assistive devices.
o Wound dressings: Choosing dressings that keep the wound moist, absorb discharge, and prevent further trauma or infection.
o Infection control: Using oral or N antibiotics, depending on infection severity.
o Vascular procedures: Performing angioplasty or bypass surgery in cases of poor circulation.
o Blood glucose management: Keeping blood sugar levels stable to aid healing and prevent recurrence.
o Nutritional support: Ensuring adequate nutrition to promote tissue repair.

The Cornerstone of Well-being: Prevention is Key

While effective treatment is crucial, the ultimate goal is to prevent DFUs from occurring in the first place. This requires a proactive approach to foot care and education.

Key preventive measures include:

o Regular foot examinations: Individuals with diabetes should inspect their feet daily for any cuts, blisters, redness, or swelling. If they cannot see their feet properly, they should use a mirror or ask for help.
o Proper foot hygiene: Washing feet daily with lukewarm water and mild soap, and drying them thoroughly, especially between the toes.
o Moisturizing: Applying a moisturizing lotion to prevent dry skin and cracking, but avoiding application between the toes.
o Wearing appropriate footwear. Choosing comfortable, well-fitting shoes that provide adequate support and protection.
o Avoiding walking barefoot or in ill-fitting footwear.
o Avoiding extreme temperatures: Protecting feet from hot and cold surfaces.
o Regular nail care: Trimming toenails straight across and filing any sharp edges. Seeking professional help for ingrown toenails or fungal infections.
o Smoking cessation: Smoking significantly impairs blood flow and increases the risk of DFUs.
o Optimal blood glucose control: Maintaining blood sugar levels within the target range as recommended by their healthcare provider. Regular check-ups with a healthcare professional: Including foot examinations as part of routine diabetes care.

Steps for Positive Foot Care Behaviors:

For people with diabetes in Manipur, proper foot care isn't optional—it's essentiaL Simple daily habits can go a long way in preventing diabetic foot ulcers:

o Check your feet daily: Make foot inspections a routine, just like brushing your teeth.
o Wear the right socks: Choose clean, soft cotton or wool socks and avoid tight or synthetic ones that can reduce circulation.
o Inspect shoes before wearing: Look inside for anything that might injure your feet, like rough seams or small objects.
o Don't ignore problems: Even minor cuts or blisters need attention. Seek medical help if you notice redness, swelling, pain, or discharge.
o Stay informed: Educate yourself and your family about foot care and the risks of DFUs.

Diabetic foot ulcers can seriously affect quality of life, but they are largely preventable. Through awareness, consistent self-care, and timely medical attention, individuals with diabetes can protect their feet and maintain an active, healthy lifestyle.