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Diabetic Foot Ulcer

 

Burns   Fractures   Wound Bed Preparation

 

Leg Ulcers   Surgical Wounds   Tissue Viability
  Pressure Ulcers   Vascular Conditions   Infection & Inflammation

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Diabetic Foot Ulcer   Lymphoedema   Moisture Imbalance
  I.V. and Catheter Sites   Soft Tissue Injuries   Edge of Wound

 

Scar Management

 

Minor Wounds    

 

There are 125,000 people in New Zealand with diabetes. 11,000 people have Type 1 diabetes, with approximately 115,000 people diagnosed with Type 2 diabetes. It is estimated that 115,000 are undiagnosed, and 300,000 are at risk. Diabetes can cause damage to the microcirculation, especially in the extremities of the lower leg which often leads to loss of sensation (neuropathy) in the feet and a reduced ability to combat infection.

Foot ulceration in the diabetic patient occurs as the result of three main pathological changes: peripheral sensory neuropathy; peripheral motor neuropathy; and autonomicneuropathy. Peripheral vascular disease can also play a significant role in foot ulceration in the diabetic.

Diabetic Foot Ulcers

Peripheral Sensory Neuropathy renders the diabetic foot insensitive to pain and temperature. The patient is unable to recognise trauma and pressure through the usual feedback mechanism. Because sensation is limited, foot damage can go unnoticed and severe ulceration can occur.

Peripheral Motor Neuropathy alters the configuration of the foot due to atrophy or changes in the small muscles of the foot. The characteristic claw or hammer toes are seen which predisposes the diabetic patient to foot ulceration on the toes. Tissue underneath the toes, not normally exposed to pressure, also becomes vulnerable to ulceration.

Autonomic Neuropathy results in a decrease or absence of perspiration leading to dry, cracked feet which are prone to infection. Bacteria enter the fissures damaging the protective barrier of the soft tissue.

Lower limb foot ulcers are the leading cause of lower limb amputations in diabetics. About 15% of Diabetics have a foot ulcer at some point in their life time. Ulceration is the most common single precursor to amputation and has been identified as a component of 85% of lower extremity amputations.

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Treatment

The primary objectives for management of diabetic related foot ulcers are:

  • Promote adequate blood supply
  • Redistribute pressure
  • Debride necrotic/dead tissue
  • Minimise risk of infection
  • Improve the patient emphasis on control of the underlying diabetic condition and with daily inspection of their feet

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Product Selection

Due to the potential for infection leading to other complications and ultimately amputation, diabetic ulcers are often treated quite radically. It is common for necrotic tissue to be surgically removed with a scalpel, however more conservative debridement using moisture donating dressings are routinely used in combination with a surgical approach, or where sharp debridement is not clinically appropriate.


Alginate dressings are a popular choice for packing diabetic ulcers, especially around the toes, and Allevyn* Non-Adhesive is also effective as it helps create excellent conditions for wound healing while providing some protection from pressure and contamination. Allevyn* Heel is useful both on the heel and also to dress stumps or on the forefoot where toes have had to be amputated.

As diabetic patients often do not display the classic signs of infection, infections can progress unnoticed. Application of Acticoat* or Iodosorb* to a critically colonised ulcer assists to reduce the bacterial load.



Related Links

Diabetes New Zealand - www.diabetes.org.nz

International Diabetes Federation - www.idf.org

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