Topical Treatments For Diabetic Foot Wounds
Those with diabetes may find that their feet are more prone to dryness, itchiness, bruising, cuts, scrapes, and sores. These seemingly minor issues can be dangerous for diabetic feet. Even small wounds may heal slowly and poorly, becoming infected, or develop into diabetic foot ulcers over time. Topical medications are treatments that are applied directly to the skin to treat a skin problem. There are various topical medications that may be used to address skin conditions on diabetic feet. These include medications that moisturize the skin, protect the skin from irritants, reduce itchiness, decrease pain, disinfect wounds and aid wound healing. If you have DFU’s or other skin problems on your feet a podiatrist can help to find the correct treatment for you.
Wound care is an important part in dealing with diabetes. If you have diabetes and a foot wound or would like more information about wound care for diabetics, consult with one of our podiatrists from Boston Common Podiatry. Our doctors will assess your condition and provide you with quality foot and ankle treatment.
What Is Wound Care?
Wound care is the practice of taking proper care of a wound. This can range from the smallest to the largest of wounds. While everyone can benefit from proper wound care, it is much more important for diabetics. Diabetics often suffer from poor blood circulation which causes wounds to heal much slower than they would in a non-diabetic.
What Is the Importance of Wound Care?
What Causes Foot And Toe Ulcers How Do You Get An Ulcer
There are many possible causes. The most common include:
- Neuropathy from diabetes.
- Peripheral arterial disease.
- Deformed toes.
- Walking in an odd way where you put too much pressure on one part of your foot or toe.
- Friction. Your foot or toe may rub against the toebox of your shoe.
Assessing The Effectiveness Of Therapy
Parameters that should be assessed in determining the effectiveness of antibiotic therapy of diabetic foot infections include the patient’s temperature and other vital signs, white blood cell count and other inflammatory markers, glycemic control and other metabolic parameters, signs of wound inflammation and how the patient is feeling. Cellulitis may initially appear worse after treatment, as bacterial toxins are released after antibiotic attack. Most other properly treated wounds will begin to have less purulence, tenderness and erythema within a day or two. With osteomyelitis a falling sedimentation rate is reassuring if doubt remains a repeat radionuclide leukocyte scan that no longer shows increased bone uptake is reassuring. There is rarely a need to re-culture a wound if the patient is responding to therapy. Wound healing is a separate issue from infection response, though the former will rarely progress without the latter.
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When You Need More Treatment
If your wound doesnât heal in about a month or becomes an infection that spreads to the bone, you may need other treatments. These can include surgery and hyperbolic oxygen therapy, which involves breathing pure oxygen in a special room in order to help your body heal.
If your ulcer develops gangrene and your tissue dies, your doctor may have to amputate that area of your body.
Who Can Get A Diabetic Foot Ulcer
Anyone who has diabetes can develop a foot ulcer. Native Americans, African Americans, Hispanics and older men are more likely to develop ulcers. People who use insulin are at a higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers.
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How To Prevent Foot Ulcers
Here are some tips to preventing foot ulcers:
- Control the sugar in your blood. Keeping the blood sugar levels under control is the best way to avoid diabetic foot ulcers. Uncontrolled glucose is often behind neuropathy, which causes loss of sensation in the feet, making it possible for a sore to go unnoticed. Maintaining normal glucose levels would also allow any foot sores to heal more quickly. This will help avoid developing ulcers.
- Pay attention to your feet. I f you have diabetes, it’s necessary to perform regular foot inspections. Catching a sore early will go a long way in preventing major issues. Try this: Place a mirror on the floor and hold over it with each foot. Or ask a family member to inspect all areas of your feet periodically.
Other preventive measures include
- Do not walk bare feet.
- Stay off your feet in order to prevent pain and ulcerations. This is called off loading which is helpful with some types of ulcers.
- Consider wearing diabetic shoes, casts or foot braces.
- Keep your feet clean and dry
Topical Antimicrobial Agents For Treating Foot Ulcers In People With Diabetes
We reviewed the evidence about whether or not antimicrobial agents can prevent or treat foot infections in people with diabetes when they are applied topically . We wanted to find out if antibacterial treatments could help both infected and uninfected wounds to heal, and prevent infection in uninfected wounds.
People with diabetes are at high risk of developing foot ulcers. These wounds can cause discomfort and often become infected. Diabetic foot ulcers that do not heal can result in amputation of part or all of the foot or even the lower leg. Antimicrobial agents, such as antiseptics and antibiotics, kill or prevent bacteria from growing, and are sometimes used to treat diabetic foot ulcers. Antimicrobials may be used either to reduce infection or promote healing in infected wounds, or to prevent infection or promote healing in wounds where infection has not been detected. We wanted to find out whether antimicrobial treatments were effective in either of these cases which treatments were most effective and if those treated experienced any harmful side effects.
Quality of the evidence
Overall, the certainty of the evidence provided by the trials was too low for us to be certain of the benefits and harms of topical antimicrobial treatments for treating foot ulcers in people with diabetes. More, larger, and better-designed randomised controlled trials should be carried out in this area.
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Choice Of Antibiotics In Diabetic Foot Ulcers
Choice of Antibiotics in Diabetic Foot Ulcers To the Editor. In the October issue of the Archives, Wheat et al1 published a timely and interesting article regarding foot infections in diabetic patients. They report the bacteriologic findings of 131 diabetic foot infections, and also the percentage of patients whose bacterial isolates were susceptible to various antibiotics, singly and in various combinations. For instance, they say that cefazolin sodium would have adequately treated 41% of their patients cefoxitin sodium, 58% of their patients moxalactam disodium, 68% of their patients cefoxitin with ampicillin sodium, 74% of their patients ticarcillin disodium and clavulanic acid, 85% of their patients moxalactam with ampicillin, 94% of their patients cefoxitin with ampicillin and an aminoglycoside, 96% of their patients and imipenem sodium, 100% of their patients.Some infectious disease experts recommend cefazolin with metronidazole as an inexpensive empiric treatment for diabetic foot infections, pending cultures. I would be curious about the percentage ofContinue reading > >
Types Of Diabetic Ulcers
- Neuropathic ulcers happen because of peripheral diabetic neuropathy, but without ischemia occurrence by PAD.
- Ischemic ulcers happen when the PAD is present without any sign of diabetic peripheral neuropathy.
- Neuroischemic ulcers take place when the patient has both the conditions initiating from peripheral artery disease.
Picking the right diagnosis and finding the cause of the diabetic ulcer is important for proper diabetic foot ulcer treatment.
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Who Gets Foot And Toe Ulcers
Youre at higher risk for foot and toe ulcers if you are:
- Native American.
If you have an eye, kidney or heart disease related to diabetes, youre also at a higher risk. About 15% of people with diabetes will get an ulcer, typically on the bottom of their foot. Around 6% of that 15% will have to be hospitalized because of complications.
Youre also at a higher risk of getting foot and toe ulcers if you have any of the following:
- Problems with circulation.
- A foot deformity like a bunion or hammertoe.
- Kidney disease.
- Use alcohol.
Identifying Symptoms And Diagnosis
One of the first signs of a foot ulcer is drainage from your foot that might stain your socks or leak out in your shoe. Unusual swelling, irritation, redness, and odors from one or both feet are also common early symptoms.
The most visible sign of a serious foot ulcer is black tissue surrounding the ulcer. This forms because of an absence of healthy blood flow to the area around the ulcer.
Partial or complete gangrene, which refers to tissue death due to infections, can appear around the ulcer. In this case, odorous discharge, pain, and numbness can occur.
Signs of foot ulcers are not always obvious. Sometimes, you wont even show symptoms of ulcers until the ulcer has become infected.
Talk with your doctor if you begin to see any skin discoloration, especially tissue that has turned black, or feel any pain around an area that appears callused or irritated.
Your doctor will likely identify the seriousness of your ulcer on a scale of 0 to 5 using the Wagner Ulcer Classification System:
- 0: no open lesions may have healed lesion
- 1: superficial ulcer without penetration to deeper layers
- 2: deeper ulcer, reaching tendon, bone, or joint capsule
- 3: deeper tissues involved, with abscess, osteomyelitis, or tendonitis
- 4: gangrene in a portion of forefoot or heel
- 5: extensive gangrenous involvement of the entire foot
Ulcers in people with diabetes are most commonly caused by:
- poor circulation
- nerve damage
- irritated or wounded feet
Infection of a foot ulcer can be prevented with:
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Locilex: Clinical Study Results
Pexiganan acetate has been found to have a broad spectrum of antimicrobial activity against many gram-positive and gram-negative aerobic and anaerobic bacteria and certain species of fungi.
In vitro, 91% of aerobic strains of bacteria were susceptible to pexiganan, similar to the 91% for ofloxacin and 92% for ciprofloxacin. Only enterococci required the highest concentrations of pexiganan for eradication. Of the anerobes tested, 97% were susceptible to pexiganan. Thirty percent of candida isolates were inhibited by the drug.
In vivo studies have shown a 5-log reduction in the numbers of Pseudomonas aeruginosa in swine skin wounds and a 4-log reduction in perineal skin flora on human skin following topical application. Several large-scale clinical studies have been completed evaluating the drug in the treatment of infected diabetic foot ulcers. These were designed to compare the efficacy of pexiganan to that of the fluoroquinolone ofloxacin, which is recognized as being a standard of antibiotic therapy for infected diabetic ulcers.
How To Treat Ulcers
If you do get an ulcer or notice a change in your skin that youâre not sure about, tell your doctor right away. Youâll likely get a procedure called debridement, which removes unhealthy tissue from the wound to spur healing.
Your doctor will also work with you to try to keep your sore or ulcer from getting infected and becoming bigger. Some of the steps they may recommend include:
Clean your ulcer daily. Use soap and water, unless your doctor recommends another cleanser. Donât use hydrogen peroxide or soak your wound in a bath or whirlpool, because this could reduce healing and may boost your odds of infection.
Keep your ulcer bandaged or covered with a wound dressing. While you may have heard that itâs important to âair outâ wounds, experts now know that not covering a wound actually increases the odds of infection and slows healing.
Keep pressure off your ulcer, especially if itâs on your foot. This may mean you need to use crutches, special footwear, a brace, or other devices. Reducing pressure and irritation helps ulcers heal faster.
Use the topical medications your doctor recommends. These may be saline, growth factors, and/or skin substitutes.
Keep your blood sugar under control. In addition to reducing your risk of ulcers, tight blood sugar control helps your body heal existing ulcers.
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Diabetic Foot Pain And Ulcers: Causes And Treatment
Diabetic foot pain is common amongst diabetic patients and can become severe when left untreated. Diabetic foot ulcers are the sores that are usually seen on the foot pad and it occurs in around 15% of the diabetic patients. The risk of lower-extremity amputation is increased once the ulcer develops.
Do You Know Around 25% Of Diabetics Face Amputations Due To Unhealed And Untreated Wounds
Bumps, blisters, scratches, and cuts are usually a part of life. Slapping on a Band-Aid or dabbing some antibiotic ointment does the trick. But if you have diabetes, even the simplest scratch or cut can quickly snowball into an extremely serious situation.
When a person is suffering from diabetes, wounds take longer to heal, which can increase the risk of infections and other complications developing. A person who handles their diabetes well can improve the rate at which wounds heal and reduce the chances of developing a severe infection sometimes leading to amputations.Amputation is the removal of a limb by trauma, medical illness, or surgery. It is an extreme precaution taken when a wound does not heal for a long time. Diabetes is one of the major reasons that lead to slow healing. It often leads to gangrene and amputations.
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Future Of Antibiotic Therapy Of Diabetic Foot Infections: Needed Studies
What studies are needed to improve our treatment approach to antibiotic therapy for diabetic foot infections? Several questions can be relatively easily answered by prospective studies. I hope that the growing network of investigators interested in this serious and common problem will develop protocols that will provide us with new evidence to address these issues.
Clinically uninfected foot ulcers: Will using antimicrobial agents improve healing rates? Will they reduce the occurrence of infectious complications ? If used, what route is most effective, practical and cost-effective?
Infected lesions of all types: What are the optimal antibiotics for treating these infections? What dose and duration of therapy are needed? What clinical and laboratory findings are helpful in determining when antibiotic therapy can be discontinued? What is the value of wound Gram stain and cultures in selecting antibiotic therapy? Which organisms isolated from appropriately obtained cultures need to be covered by the selected regimen?
Mild to moderate soft tissue infections: Which lesions are amenable to therapy with oral antibiotic agents? Which patients can be treated as outpatients? Is continued antibiotic therapy beyond the point of resolution of clinical infection needed? What is the role of topical antibiotic agents in treating appropriately selected infections?
How Should A Diabetic Foot Ulcer Be Treated
The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing of the wound, the less chance for an infection.
There are several key factors in the appropriate treatment of a diabetic foot ulcer:
- Prevention of infection
- Taking the pressure off the area, called off-loading
- Removing dead skin and tissue, called debridement
- Applying medication or dressings to the ulcer
- Managing blood glucose and other health problems
Not all ulcers are infected however, if your podiatric physician diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.
There are several important factors to keep an ulcer from becoming infected:
- Keep blood glucose levels under tight control
- Keep the ulcer clean and bandaged
- Cleanse the wound daily, using a wound dressing or bandage
- Do not walk barefoot
For optimum healing, ulcers, especially those on the bottom of the foot, must be off-loaded. Patients may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the ulcer area and help to speed the healing process.
Applying Medication and Dressings
For a wound to heal there must be adequate circulation to the ulcerated area. Your podiatrist may order evaluation test such as noninvasive studies and or consult a vascular surgeon.
Managing Blood Glucose
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How To Treat Diabetic Ulcers
While prevention plays an integral part in managing physical health conditions, diabetic ulcers can occur even if diabetes is properly managed. Treatment options can vary depending on the symptoms and individual but generally consist of medicine or natural ointments.
Diabetic ulcers are generally slow to treat. Taking pressure off the foot is crucial during the healing process. Contact casting or therapeutic boots are often recommended to reduce swelling and irritation from the ulcer. Bandages and other types of wound dressing can usually be found in local pharmacies.
Medications are sometimes used for diabetic ulcers to normalize glucose and heal any potential infection. Hyperbaric oxygen therapy is one method of treatment that can be used as well as surgical debridement. By removing dead tissue, certain diabetic ulcers can be treated by medical professionals.
Natural ointments are also used for certain types of diabetic ulcers. Since homeopathic treatments that reduce inflammation can help with pain reduction, this can be a beneficial treatment for healing while allowing the individual a level of comfort.
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Diabetic Foot Ulcer: Treatment And Prevention
Estimates are that by 2030 there will be 550 million individuals with diabetes in the world. Because almost a quarter of all people with diabetes will develop a foot ulcer at some point, health care workers need to know the best practices for diabetic foot ulcer prevention and treatment.
Determining which diabetic foot ulcer type is important to determine an effective treatment. Here are the different types of these wounds:
- Neuropathic ulcers arise when the nerve damage from diabetic neuropathy causes the individual with diabetes to not feel pain from an injury, which often leads to the ulcer progressing substantially before the person is even aware of it. Foot and toe deformities, corns, calluses and areas repetitive stress are likely places of injury. Footwear can not only hide these issues, but can exacerbate the injury if the shoe is ill-fitting.
- Ischemic ulcers or arterial ulcers as they are sometimes called may occur due to lack of blood flow to the extremity. When an ulcer occurs as the result of an injury to the extremity, the lack of blood flow makes these ulcers difficult to heal.
- Neuroischemic ulcers occur in individuals with both neuropathy and poor arterial blood flow and are the most difficult to heal.
- Infected wounds occur in about half of patients with a diabetic foot ulcer and require particularly close care.
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