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Diabetic foot ulcer (DFUs) are chronic wounds that can develop on the foot or lower extremities of people with diabetes. If not properly treated, diabetic foot ulcer can result in serious complications, including amputation. Getting timely treatment is one of the best things you can do to ensure a foot ulcer or damage does not become too demanding or threatening in life. Preventive measures can contribute significantly in eliminating the risks of diabetic complications (as foot problems), though the possibility may not be completely eliminated even with utmost preventive measures. With diabetes, even a normal ulcer or wound can become overwhelming and lead to complications over time. Wound dressings are of many types.  The Hydrogel dressings may score more over other types of dressings although there is no concrete evidential testament for the same. Many other types of moist dressings can be implemented including adhesive backing film and silicone coated foam. Being a primary complication of diabetes mellitus, diabetic foot ulcers need prompt and timely intervention lest they become damaging causing amputation. Failure of wound healing arising out of chronic diabetes can often be treated with the extracellular matrix replacement therapy. In this diabetic ulcer treatment, vacuum is used to remove the extra fluid and cellular waste from a wound. Treating foot ulcers and damages can be a tricky task because what may apparently seem fine may not actually be so.
An index of 0.9 or less indicates that you should consult a vascular surgeon for clarity on medical intervention. However, with good foot care, by wearing proper footwear and by keeping the blood sugar level under control, the risk of developing foot ulcers can be diminished. The role of footwear in the diabetic foot ulcer treatment process should not be overlooked.
Although most cases of diabetic foot ulcers can be cured with antibiotics, in a small number of cases surgery is carried out to remove the pressure from the foot ulcer site. In traditional Chinese medicine, Radix Rehmanniae and Radix Astragali are widely recommended for treating foot ulcers. According to an Italian study, regular intake of French maritime pine bark extract can rapidly heal foot ulcers in diabetics.
In a study, researchers at the University of Wisconsin Medical School in Eau Claire found that applying honey on the ulcer helps to cure the wound.
In diabetics, reduction in nitric oxide production slows down the wound repairing mechanism.
According to the 2005 Australian AusDiab Follow-up Study, around 1 million Australians are diagnosed with diabetes with another 16.3% classed as pre-diabetic. Diabetes is associated with reduced circulation (peripheral vascular disease) and nerve damage (peripheral neuropathy) in the lower extremities.
The current prevalence rate of foot ulcers lies at 1.7% of adults attending a diabetes clinic20.
The non-invasive and quick treatments can easily be integrated into current protocols (i.e.
Inflammatory ModulationAfter PACE treatment the wound moves quickly through the inflammatory phase (increase in leukocyte activity) to the cell duplication phase (proliferation) of healing. Cytokines and ChemokinesInflammatory and pro-angiogenic phases are accompanied by increases of cytokines and chemokines 6 hours after and up to 7 days post-treatment. Growth factor UpregulationPACE treatments apply mechanical forces to the individual cells in the treatment area and thus, creating a biological response called “cellular expression”.
GranulationGranulation or cellular proliferation describes the stage when cells multiply to cover and close the wound. EpithelializationA recent phase III clinical trial strongly suggests that dermaPACE has an effect in the stabilization, size reduction and with time, complete re-epithelialization of wounds specifically diabetic foot ulcers (DFU). Diabetes causes three conditions that affect the feet: poor circulation to your feet, reduced sensation or numbness of your feet, and a diminished healing capacity.
Diabetic foot ulcer is a main complication of people suffering from diabetes type 1 or type 2.
Diabetes is a group of metabolic diseases characterized by high levels of sugar in the blood resulting in a deficiency in the function and secretion of the insulin. Diabetic foot ulcer can either be from neuropathic or vascular complication of the disease.
A foot ulcer usually develops on the surface of the skin or may also develop in the deeper layer of the skin. Diabetic foot ulcer generally exists in two types which are classified according to their origin while each type has their own symptoms. Pain is often absent for most of its cases and the severity is generally rated from 0 to 3 with 0 being the mildest while 3 being the most severe in extent. The tissues surrounding the ulcer are black in color as a result of insufficient blood flow to the affected foot. The presence of intermittent claudication is manifested by fatigue or cramping of the major group of muscles in either one or both extremities. The onset of diabetic foot ulcer is being linked to the complications of the disease in the nerve and in the blood vessels.
The treatment of diabetic foot ulcer requires bandaging or wound dressing of the affected foot. It is also necessary to determine if the ulcer that developed is neuropathic or vascular or a combination of both in nature.


Neuropathic ulcer requires protection from further injury while the wound is in the process of healing. Vascular ulcer generally requires a careful examination and evaluation from the surgeon to identify the extent of the damage whether partial or complete amputation is necessary or if amputation is necessary at all. The health information provided on this web site is for educational purposes only and is not to be used as a substitute for medical advice, diagnosis or treatment. DFUs often occur from complications of diabetes-specifically, peripheral neuropathy, a condition in which feeling, or sensation, is lost due to reduced blood flow to the lower extremities.
Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in 12-week prospective trial.
Healing of chronic foot ulcers in diabetic patients treated with a human fibroblast-derived dermis. Diabetes has a strong background of affecting foot in vivid ways and ulcers are one of the several ways. Thereafter, you may cover the part to avoid further damage or infection to the area; for expert advice, a local wound center can be contacted. A custom-designed boot can be used to provide support and necessary healing to the affected area.
About 84% of all lower leg amputations are a result of diabetic foot ulcers which are mainly considered to be an outcome of macro and micro vascular complications.
In diabetes, foot care and treatment considerably rests on using techniques like advanced moist wound therapy, skin substitute and negative pressure wound therapy.
This treatment requires expert administration and there are some basic guidelines which should be adopted when implementing this therapy for beneficial outcomes in treating ulcers and wounds. It may signify a 50% blockage of an important artery. The doctor may also want to clean the foot sore (debridement) and check the area for bacteria. Poor blood circulation combined with numbness in the feet owing to diabetic neuropathy significantly slows down the wound repair process, complicating the foot injury, which might even lead to amputation. Despite regular care, if an ulcer develops in the feet, it can be cured with proper treatment. Physicians usually refer patients with foot ulcers to specialists who design shoes to relieve pressure from the site of the injury. Surgeries help to correct certain deformities on the foot such as bunions, hammertoes, heel spurs and flat feet. Laboratory studies have revealed that herbal preparations containing these herbs can heal foot ulcers even in people with uncontrolled diabetes that do not respond to insulin treatment. The active components in the pine bark supports wound healing by improving glucose metabolism, increasing circulation and reducing inflammation.In Ayurveda, herbal preparations containing antibacterial herbs such as Tinospora cordifolia, Embilica, officinalis, Rubia cordifolia, Gycyrrhiza glabra, Balasmodendron mukul and Moringa psterygosperma are used for treating diabetic foot ulcers. It is likely to be an even greater problem than these figures indicate, as it is estimated that for each person diagnosed with diabetes, another diabetic is undiagnosed.
These two factors increase the risk of diabetic or neuropathic wounds in diabetic patients. Such diabetic ulcers can usually be found in the lower limb region and are called diabetic foot ulcers.
Diabetes is estimated to account for approximately half of all non-traumatic amputations 17. PACE treatment results in an increase in perfusion and arteriogenesis, biofilm disruption, a pro-inflammatory response, cytokine and chemokine effects, growth factor upregulation, angiogenesis (new blood vessel formation) and the subsequent regeneration of tissue such as skin, musculoskeletal and vascular structures. This describes the incidence when the cells produce wound healing proteins called pro-angiogenic growth factors.
VEGF (vascular endothelial growth factors) indicate the growth of new capillaries to allow an improved blood flow in the wound.
Research has shown that after PACE treatment, there is a significant increase of proliferative cells which indicates that PACE treatments may accelerate wound granulation.8 Stojadinovic et al (2008) reported marked granulation tissue development on post-treatment day 4. Epithelialization of greater than 90% was demonstrated to have statistical importance at 12 weeks in favour of PACE treated wounds compared with the placebo group. Andrew Schneider is a podiatrist and foot surgeon at Tanglewood Foot Specialists in Houston, TX.
The onset of diabetic foot ulcer puts a diabetic patient at greater risk for limb loss or amputation. The incidence of diabetes overtime can lead to various problems in health such as kidney failure, blindness and nerve damage.
A foot ulcer is characteristically a sore that develops on the surface of the skin but can also be deeper in the skin. It resembles a reddish crater that is usually located at the side or at the bottom of the foot or may be on the top or at the toe tip. The foot unlike in neuropathic ulcer is often cool to touch and the skin is thin and shiny. No ulceration observed at the risk foot is rated as 0 while superficial ulceration with no noted infection is rated as 1.
The foot is made vulnerable when it is deprived of cell oxygen due to insufficient supply of oxygenated blood. In case diabetic foot ulcer already occurred, the goal of treatment is to prevent infection and to prevent further complications including possible amputation of the affected foot. It also requires antibiotic treatment, debridement including platelet-rich fibrin therapy and arterial revascularization. The dressing can be in the form of hydrogel dressing, hydrocolloids and absorptive fillers. Identifying the nature of the ulcer will help in determining the method of treatment appropriate to the patient.


Several methods of protecting and treating the wound should be strictly followed to enhance healing while frequent skin assessment is also necessary to monitor the improvement or the progression of the foot ulcer.
Among people with diabetes, approximately 15% experience a DFU in their lifetime, and approximately 2.5% develop a DFU each year. In the United States, approximately 60% of all lower extremity amputations occur among persons with diabetes; of these amputations, approximately 85% are preceded by a foot ulcer. These boots can be crucial for healing of foot and can considerbly reduce the scope of amputation.
For instance, the moist wound therapy is believed to processes as fibroblast proliferation, collagen synthesis, and wound contraction. If no improvement is noticeable within a day or two after using the antibiotic medication, your physician might change the drug.
Your physician might ask you to visit a podiatrist who can cure corns, calluses and ingrown toenails. Peripheral circulation in diabetics can be improved with ginseng, ginkgo, goldenseal and burdock.
This makes a total of around 1.7 million Australian diabetics (diagnosed and undiagnosed)15.
Saggini et al (2008) reported considerably increased granulation tissue in the wounds of treated patients after shock wave treatment. Poor circulation, known as peripheral artery disease (PAD) prevents sufficient blood flow to the feet, depriving the tissues of needed oxygen.
The risk for amputation is increased eight fold that health professionals play a vital role in managing and preventing lower extremity ulcer among their patients. Millions of people all over the world are being affected with diabetes and it is regarded as the 7th leading cause of death. People with diabetic foot ulcer are prone to suffer from infection due to an open wound while the ulcer generally takes longer time to heal or may not heal at all. There is also no presence of a pulse and pain while intermittent claudication and atrophy of the subcutaneous tissue can be observed. The presence of deep ulceration with an exposure of tendons or bones is rated at 2 while deep ulceration or with the presence of abscesses is rated as 3. Other symptoms of diabetic foot ulcer include ischemic pain at rest, development of non-healing ulcer or sore on the foot. Additionally, the rate of amputation for people with diabetes is 10 times higher than for people without diabetes. In a University of California, San Diego study, researchers found that tretinoin, a vitamin A derivative, commonly used for treating acne, can heal diabetic foot ulcer. The total figure of Australians with diabetes and pre-diabetes is estimated at 3.2 million16. 8 Other studies compared ESWT with topical VEGF application in ischemic tissues and shock wave treatment outperformed VEGF application.
Overall PACE treated wounds were twice as likely to achieve 90-100% wound closure compared with sham-control patients within 12 weeks. Peripheral neuropathy, a numbing of the nerves in the feet, reduce the protective sensation and reduces the likelihood that someone with diabetes will feel pain with an injury. Diabetic foot ulcer is among the problems or complications that can arise from chronic disease which makes an affected individual at high risk of losing a limb. When an infection occurs, a pocket of pus and cellulitis may develop including bone infection. People with peripheral neuropathy is unable to perceive pain when they stepped on something sharp or when their feet is in discomfort or when the feet is already injured or wounded unless given a closer look.
Stubborn wounds are treated with intravenous antibiotic injections to accelerate the healing process.
The reduces healing potential can make a trivial injury more problematic by becoming infected and putting the limb at risk. Gangrene may later occur which can lead to poor circulation subsequently amputation or a loss of a limb.
To increase the effectiveness of the medication, blood sugar level needs to be lowered with medicines and diet.
When there is pressure beneath the foot or over bony prominences, such as bunions or hammertoes, thick skin, or calluses, will often form to protect from the increased pressure. In the case of nerve that is not functioning, the pain is not felt and the presence of the foot ulcer may not be noticed. Because of reduced circulation and the diminished ability to heal, the tissue beneath the pressure will breaks down and a diabetic foot ulcer will form.
The open foot ulcer, a break or hole in the skin, can deepen and become infected, putting the bone at risk for infection and threatening the health and safety of the limb. If you notice that you have, or at risk for, a diabetic foot ulcer, consider it an emergency and call your Houston podiatrist. At Tanglewood Foot Specialists, we specialize in keeping our diabetic patients healthy and walking.



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