Foot ulcer in diabetics: an underestimated gravity
Foot ulcer is a formidable complication of diabetes. In fact, 85% of amputations are preceded by ulceration. If treatments have progressed, diabetics remain poorly informed about this “plantar perforating disease”.
Diabetic foot ulcer: a sneaky evil
In diabetics, foot ulcer results from 3 mechanisms:
- Nerve damage (neuropathy) leading to loss of sensation, deformity and dryness of the skin;
- Damage to the blood vessels (arterial disease) of the leg: the foot of the diabetic is no longer properly supplied with blood, which can cause necrosis;
- A secondary infection that aggravates the ulcer. It is classified from grade 1 (uninfected ulcer) to 4 (ulcer infected with fever).
Triggers include minor injuries such as unsuitable shoes, nails, walking barefoot. Due to loss of sensitivity, these superficial injuries are often ignored by the patient. This is why 40% of diabetic foot ulcers are accidentally discovered.
The treatment of diabetic foot ulcer is preferably done in a specialized center. It includes cleaning the wound, making dressings, taking antibiotics (Regranex, for example) and especially a strict discharge.
The discharge consists in avoiding the support of the ulcer on the ground. This involves the patient’s bed rest, the use of crutches or devices such as orthopedic shoes or plaster. Non-removable plaster discharges are the most effective according to Dr. Faure, pharmacist at Montpellier University Hospital. These kinds of resin or plaster boots cover the entire foot and leg to the knee. Inside, inflatable pads protect the foot. During walking, the pressures are distributed over the entire arch and a large part is evacuated upwards because of the rigidity of the system.
These boots can be paired with connected socks that detect changes in pressure or temperature.
Although speed of management is paramount to successful treatment, people with diabetes often delay seeking help. 30% consult after 1 to 6 months and 14% after 6 months. 50% underestimate the severity of the condition. It’s not much better for doctors: 27% of patients say that their GP never examines their feet.
On the sick side, a lack of information seems to be responsible for this underestimation. 29% say they have not been informed of the risks.
Patient education is essential in the context of prevention. For the management of diabetic foot ulcer, it includes information on:
- Loss of sensitivity;
- Daily self-examination of the feet (possibly with a mirror);
- The wearing of adapted shoes, socks reversed seams every day;
- The ban on barefoot walking;
- Hygiene: daily washing, rigorous drying and application of a moisturizer;
- Nail cutting, possibly by a chiropodist.
Finally, in case of wound, even minimal: washing with soap and water, covering with a sterile compress, elimination of the cause of the injury (e.g. new shoes). And especially immediate consultation!