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... slow to heal. [ 1 ]. Any break in the skin is serious and can be from abnormal wear and tear, injury, or infection. Calluses and corns may be a sign of chronic trauma to your foot. Toenail fungus, athlete's foot, and ingrown toenails may lead to more serious bacterial infections. [ 1 ].
Another sign of infection is drainage of pus from a wound. But if drainage is persistent and bloody it can be a sign of a more serious foot problem. A limp or difficulty walking is generally a sign of serious infection, or joint problems, or just improperly fitting shoes. Fever or chills in association with a wound on the foot can be a sign of a limb- or life-threatening infection. [ 1 ]. Red streaking away from or redness spreading out from a wound is a sign of a progressively worsening infection. [ 1 ].
And finally, there are the symptoms that refer to diabetic foot ulcers: Persistent pain may be a symptom of bruise, sprain, improperly fitting shoes, strain, overuse, or underlying infection. Redness especially if it surrounds a wound can be a proof of infection, or of abnormal rubbing of socks or shoes. Swelling of the feet or legs shows that there is an underlying infection or inflammation, or also poor venous circulation, or improperly fitting shoes. 6) Nursing treatments including dressings, wound care, medications After diabetic foot ulcers are successfully diagnosed, they must be treated. According to Robert G. Frykberg, (2002) the primary goal in the treatment of diabetic foot ulcers is to obtain wound closure. [ 9 ].
Management of the foot ulcer depends on the presence of infection, severity (grade) and vascularity. And it is important that all diabetic foot lesions should have a systematic approach to their treatment. This approach is needed because foot ulcers are known to bear a multifaceted nature and more than that this foot disorder may cause numerous comorbid ities in the patients. First, the affected foot should be relieved of pressure and elevated.
Ill-fitting footwear must be replaced with any type of pressure-relieving footwear, for example a postoperative shoe. In order to off-load pressure from the affected foot, it is recommended to use crutches or a wheelchair. Although the best method of management for neuropathic ulcers is believed to be total contact casting, it requires considerable experience in order not to cause iatrogenic lesions and thus it should be reapplied weekly. An alternative to this method may be the "half shoe" or removable walking braces. Then, the tissue that is callus, necrotic, and fibrous must be removed. It is unhealthy and must be decided back to the tissue that is bleeding.
This will allow full visualization of the ulcer, its extent, and will help to detect underlying processes such as abscesses or sinuses. For this purpose topical enzymes are not effective considered and should be taken only as adjuncts to sharp debridement. It should be avoided to soak ulcers because they are controversial and the patient may be scalded by hot water. Next, the wound must be treated with medications. Although there are many promoted medications and gels for ulcer care, relatively few have proved to be more efficacious than saline wet-to-dry dressings. [ 9 ]. There are antiseptics that are considered to be toxic for healing wounds.
Povidone-iodine belongs to them. In this way it is determined that a warm, moist environment that is protected from external contamination is most conducive to wound healing. [ 9 ]. This can be provided by a number of special dressings that are commercially available. These dressings include: foams, semipermeable films, calcium alginate swabs and hydro colloids.
Michelle Gardner in the article Wound Healing: Uneventful Process or Complex Medical Problem Requiring Specialized Treatment and Care? gives the following explanation of each type of dressing: Foam is meant to absorb heavy drainage, and help promote a moist environment and automatic debridement. Calcium alginate's come from brown seaweed and absorb 20 times their weight. They keep a wound moist, and helps automatic deciding of the wound. Hydrogels hydrate a dry wound with minimal absorption, soothing and promoting wound healing.
Hydrocolloids are impermeable to bacteria and aid in automatic debridement, self-adherence, and moist healing. They may be left in place for 3 to 5 days, but cannot be used if infection is present. [ 6 ]. Also, together with other medications, there are genetically engineered growth factors, such as Apligraf by Novartis. Apligraf is approved by the Federal Drug Administration (FDA) on the territory of the USA and is a bi-layered living skin product.
This growth factor is used for diabetic ulcers and venous ulcers and consists of two layers: dermis and an epidermis. Matthew G. Garoufalis, DPM. , chief of the podiatry section at VA Chicago HealthCare System, has used this product on his patients and had positive results: "We have been treating wounds for years and doing various studies with different wound care products. We are pretty well versed in what is going on in wound care, " Garoufalis said. "We use the Apligraf instead of using a skin graft.
If we were to do a skin graft on these patients with ulcers, we would have to take skin from somewhere else on their bodies and, in essence, create another wound to heal the one on their lower leg. You can imagine how complicated that could be. " [ 6 ]. To combat bugs on the wound Matthew G. Garoufalis recommended a product from Health point called Iodosorb. In his medical practice, over 20 years, Garoufalis has studied many cases of foot ulcers and used Apligraf and Iodosorb to manage them.
He claimed that this treatment result in 100 % after the period of eight weeks. "IV or oral antibiotics are dependent on blood flow to get to the wound site, " Garoufalis admitted. "If patients only have 50 % of their blood flow, how much of that systemic antibiotic is getting to the wound? Maybe not enough to take care of the bugs. If we can treat wounds topically, we are much better off, and that is what we are finding. " [ 6 ]. 7) Patient education and prevention. Prevention is one of the most important elements of wound care. To prevent the occurrence of diabetic foot ulcers, a patient must examine his feet carefully every day for blister or minor injury.
Also important is everyday washing and drying of a patients feet. This will prevent entry for gems. If the patients heels are dry or cracked, he may use E 45 cream, any of the similar preparations, to keep this area soft. Hard skin on the foot should be removed carefully by podiatrist (chiropodist). Also the patient should be aware if nerves and blood circulation are affected by diabetes. In case the patient has such problems, it puts his feet at risk right away.
In addition, the patient should find out whether his eyesight is good and allows his to cut his own toenails safely. The patient should not cut his toenails too short, especially at the sides. It will be safer to file them or to undertake foot care provided by a qualified chiropodist. The patient should avoid proprietary corn cures and let his doctor, or diabetes nurse know if there are any changes in the colour of the skin. Finally, the patient with diabetes must avoid walking barefoot and get an expert help when he buys new shoes: to make sure that the ones he buys are not too small for him. Also, there are things that a person with diabetes should learn.
This is called patient education. According to Robert G. Frykberg, (2002), there are major things, which are necessary to be learnt by patients in order to prevent them form diabetic foot ulcers. First, diabetics should know how to examine their own feet and how to recognize the early signs and symptoms of diabetic foot problems. [ 9 ] And additionally, people with diabetes should learn what is reasonable to do at home as far as routine foot care, how to recognize when to call the doctor, and how to recognize when a problem has become serious enough to seek emergency treatment. [ 9 ]. Bibliography: Bill O'Halloran. (2005) Diabetic Foot Ulcer. Retrieved March, 7, 2005, form health.
discovery. com / encyclopedias / 2759. html Diabetic Foot Care (2004) eMedicine. com Retrieved March, 7, 2005, form web Falanga V. Wound bed preparation and the role of enzymes: A case for multiple actions of therapeutic agents. WOUNDS 2002; 14 (2): 4757.
John Wiley. (2002). Foot Complication Diabetes Surgery Door Newsletter. Retrieved March, 7, 2005, form web Indices/F/footcompdiabetes. htm Micheal D Rush (2001). Diabetic Foot Care. Diabetichelpcom.
Retrieved March, 7, 2005, form web Michelle Gardner. (2005). Wound Healing: Uneventful Process or Complex Medical Problem Requiring Specialized Treatment and Care? Surgicenteronline. Retrieved March, 7, 2005, form web Ohio SO, Jude EB, Tarawneh I: A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas wound classification systems. Diabetes Care 2001 Jan; 24 (1): 84 - 8 Richard M Stillman (2004). Diabetic Ulcers.
eMedicine. com, Inc. Retrieved March, 7, 2005, form web Robert G. Frykberg, (2002), Diabetic Foot Ulcers: Pathogenesis and Management. American Academy of Family Physicians.
Retrieved March, 7, 2005, form web
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