Diabetic Foot Ulcer: Role of a Vascular Surgeon

If you have diabetes, having too much glucose (aka sugar) in your blood for a long time can cause some serious complications, including foot ulcers/foot problems.

A diabetic foot is a long-term (or “chronic”) complication which affects directly from Peripheral Arterial Disease (PAD) and/or sensory neuropathy related to diabetes.

What Are Common Foot Problems With Diabetes?

• Athlete’s foot
• Fungal infection of nails
• Calluses
• Corns
• Blisters
• Bunions
• Dry skin
• Diabetic ulcers
• Hammertoes
• Ingrown toenails
• Plantar warts

Magnitude of the problem in India

• Diabetic population : 40 million
• Foot complications : 39 %
• Compromised blood circulation: 15 %
• Neuropathy : 30 – 50 %
• 15 %of Diabetics would develop foot ulcers in their lifetime.

How diabetic foot problem develops?

High or unstable blood sugar levels, the hallmark of diabetes, can cause the arteries to change, which can choke off or damage nerves. This is known as diabetic neuropathy, and it initially feels like a tingling or pins-and-needles sensation, then burning, and finally numbness and lack of feeling in the foot.

Diabetic foot ulcers are usually the result of minor trauma, such as a blister or callus. They often appear under bony pressure areas, such as the heel or bottom of the foot. Normally, a person who develops one of these on their foot would feel pain and walk differently or wear different shoes to avoid putting additional pressure or friction on it. But if you have diabetic neuropathy, you won’t feel that pain. You’ll keep wearing the same shoes and walking on it just as you always do, leading it to turn into a more serious wound.

Unfortunately, we often don’t see people with diabetic foot ulcers until the wound is advanced and an infection has begun to set in. They may not have felt the pain of the wound, but the infection is now making them sick, causing fever, chills and swelling or redness in the leg.

You may be able to avoid getting to this point by practicing some simple foot care techniques and seeing your doctor as soon as a problem develops.

Who are at Highest risk for developing Diabetic foot ulcers?

• Uncontrolled Diabetes
• Neglected foot care
• Cracks/cuts/corns in foot
• Diabetes associated Neuropathy
• Peripheral Arterial Disease/smoking

Warning Signs of Diabetic Foot Ulcers

• Wound / ulcer development
• Foot swelling / redness
• Foot Pain
• Leg Cramps
• Blue nails / Black color of toes
• Tingling / numbness / burning in feet

How a vascular surgeon can help treat diabetic foot problems?

Vascular assessment is important part for ulcer healing process.

• Wound cleaning procedure + Antibiotics
• Complete non-weight bearing of the involved extremity (Special footwear)
• Dedicated diabetic foot wound dressing / VAC dressing
• Teaching Foot care to patients
• Revascularization (Angioplasty/Bypass) for non-healing wounds when needed.

Myths about Diabetic foot treatment

Myths

• Technically not feasible to perform
• High chances for failure of treatment
• Very costly
• Limb amputation is inevitable
• Good quality artificial legs are better for life style

Truth

• Routinely performed by experts
• Very good success rate
• It’s a cost-effective treatment
• Rarely required if treated timely
• Nothing is comparable to one’s own legs

Role of improving blood circulation in diabetic foot

Why?: To save the foot, leg.

Goal: To Maximize foot blood circulation for wound healing

Treatment options:  Angioplasty or Bypass surgery depending on the type of artery blockage.

Preventive measures to be taken

Along with treating diabetic foot conditions, there are other things we can do to prevent further problems. If you’ve had foot or vascular surgery to correct a problem, we’ll monitor you over the months and years after.

If we determine at some point down the road that there’s a new area of pressure developing, we may be able to correct it before it becomes a problem. Surgical examples include tendon lengthening or osteotomy, in which we cut or reshape a bone to relieve pressure.

We also may be able to avoid surgery with a non-invasive procedure. If, for example, you have hammertoe, in which the toe bends downward causing repeated ulcers on the tip of the toe, we could perform a percutaneous needle tenotomy. In this procedure, we use a needle to release part of the tendon from the bone.

Diabetes care doesn’t stop at controlling blood sugar. If you or a loved one has diabetes, get in the habit of practicing proper foot care, scheduling regular check-ups, and seeking early treatment for problems to prevent serious diabetic foot complications, including amputation.

 Foot Care for diabetics

• Wash Dry Moisturize your feet daily to avoid skin dryness & cracks.
• Regularly check your feet (self-examination) for warning signs.
• If you have difficulty with your vision, ask a family member to check for you.
• Get your feet assessed annually once by your doctor.
• Cut your toe nails straight across, not at corners. Gently file if any sharp edges present.
• Avoid removing callous/corns on your own, it may cause injury to your feet.
• Avoid walking bare feet.
• Don’t wear tight socks/shoes
• Avoid direct heat application on feet with hot water bag/electric heating pads.
• If you find any injury/redness/crack; immediately: Wash and dry your feet, apply antiseptic solution. Betadine & see your diabetic foot ulcers specialist/doctor.