Diabetes mellitus or diabetes is a chronic disease with abnormally high or abnormally high blood sugar levels and can cause serious complications if left untreated. One of the most common risks of complications is a diabetic foot ulcer (DFU) or diabetic foot. Diabetic foot is a type of wound affecting lower limbs of diabetic patients and as a complication of uncontrolled blood sugar. Long-term high blood sugar may cause accumulation of lipid in blood vessels and hardening of blood vessels resulting blood flow insufficiency including to lower limbs.
Diabetes can cause problems affecting feet, including Diabetic neuropathy, where there is damage in peripheral nervous system due to uncontrolled blood sugar level. In diabetic patient, there is also risk of developing peripheral vascular disease that may affect wound healing. These risk factors may cause formation of callus that further increase risk of developing diabetic foot ulcer.
Risk factors for developing diabetic foot ulcers are previous history of foot ulcer, history of amputation, anatomical foot deformities, peripheral vascular disease, diabetic nephropathy, poor glycemic control, and smoking.
Common symptoms of diabetic foot ulcer are changes in skin color, changes in skin temperature, swelling in the feet or ankles, open foot sores that are hard-to-heal, infected wound, ingrown toenails, or toenails that are infected with fungi, calluses, dry skin cracks, and unusual or persistent foot odor.
Complication of diabetic foot ulcer include skin and bone infection, abscess, gangrene, deformity and amputation. Infection in diabetic foot if left untreated may cause infection in deeper structure involving bone and surrounding tissue. Diabetic foot with gangrene often occurs due to disorder in bloow vessel supplying blood into lower limbs, causing necrotic or death tissue. Nerve damage in diabetes may also weaken lower limb muscle and cause anatomical problem such as protruding metatarsal head, higher foot arch that further complicate diabetic foot.
Management of diabetic foot ulcer should start from comprehensive management. Patient with DFU should live a healthy lifestyle and take medication to control blood sugar. Controlled blood sugar will speed up the healing process of diabetic ulcers and prevent other diabetes complications, such as kidney failure and damage to the retina.
In diabetic foot wound treatment, doctor will recommend appropriate wound dressing to treat the wound and prevent infection. Choosing proper wound dressing is very important in diabetic foot management. Ideally, wound dressing should protect the wound, and accelerate wound healing. Foam and alginate dressing is absorbent dressing, and very effective in controlling exudate in DFU. Some manufacturers of wound dressing combine foam and alginate into one packaging wound dressing, as found in Therasorb. Aside from good absorbent feature, foam alginate like Therasorb has hemostasis capacity to stop bleeding in wound due to ion exchange. Foam dressing like Therasorb C has added absorbent benefit due to 2 absorbing layers, therefore can be used in exudative wound with high amount of exudate. Thanks to flexible shape, Therasorb C is easy to be bent, folded, or even used in cavity wound, without damaging its structure. The wound treatment of DFU should also maintain periwound area, which is an intermediate boundary between wound and healthy skin. Hydrocolloid dressing such as Renoderm can be used in protecting periwound to prevent maceration due to exudate leaking. Transparant film dressing as Hiperskin can be used as secondary dressing after alginate, foam or even hydrocolloid to ensure fixation of primary wound dressing. Due to transparent feature, Hiperskin will simplify wound visualization to notice when wound dressing change must be performed.
Diabetic foot is a serious complication of diabetes. It is important for patients with diabetes to recognize diabetic foot since earlier detection can result in easier management and better prognosis. If left untreated, diabetic foot can cause serious complications. Proper blood sugar level and wound management are key factors in diabetic foot management. Choosing appropriate wound dressing can support wound treatment and accelerate wound healing in diabetic foot. With diabetes world day, we expect more people recognize and understand diabetic foot as complication of diabetes and do the efforts to prevent it.
Article Sources :
Wade D. et,al. Pathogenesis and management of diabetic foot ulcers. JAAPA. 2015; 28 ; 28-34.
- R. Hilton, D. T. et,al. Wound Dressings in Diabetic Foot Disease. Clinical Infectious Diseases 2004; 39:S100–3.
- WebMD.https://www.webmd.com/diabetes/foot-problems#:~:text=Open%20sores%20on%20the%20feet,skin%2C%20especially%20around%20the%20heel. (April, 4 2021).
- Medscape.https://emedicine.medscape.com/article/460282-treatment#:~:text=The%20management%20of%20diabetic%20foot,10%5D%20optimal%20control%20of%20blood. (April, 13 2021).
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