So while I was sitting in complete isolation and reading comics on Webtoon (For any teachers reading this, I was 100% revising my course material.. *cough cough*) I thought I would write a little something about diabetic foot ulcers since we did learn about it in first year podiatry.
This definitely isn't for someone with a weak constitution (although Ryusaki Senpai can handle anything <3) so I have left out pictures but if you're a curious cat like myself and really can't help searching up diabetic foot ulcers on google images then that is entirely up to you, but be warned, it isn't pretty.
What is a diabetic foot ucler?
Lets break it down, an ulcer is an open, deep wound. A diabetic patient is at a higher risk for developing an ulcer due to poor management of their diabetes.
An ulcer most likely cannot develop immediately and overnight, it starts of as a simple scratch or can develop as a result of abnormal plantar pressure, or even trauma to the foot. Proper footwear plays a role
How does diabetes relate to ulceration?
Excellent question! Ulceration happens in diabetic patients with neuropathy and peripheral arterial and vascular disease of the lower limb. Peripheral just means situated on the edge of something. In regards to anatomy, peripheral means nearer to the surface of the skin in relation to blood supply and nerves.
To answer the question directly, diabetes mellitus leaves the patient with a loss of sensation, and poor circulation. Loss of sensation, neuropathy, puts any diabetic patient at a risk of forming an ulcer if they can't feel whats hurting them. Also, any open wound is an open invitation for infection. Infection, if left untreated can result in amputation! Therefore, it is essential for a diabetic patient, whether high risk or low, to have a podiatrist that can keep an eye on any lower limb complications.
Treatment and Heal time: The gold standard for treating diabetic foot ulcers is: offloading, redistributing the pressure from the ulcer evenly to other areas, infection management and debridement. (you can find more information from my previous blog post on debridement!) Majority of diabetic foot ulcers heal (roughly 60-80%), some will remain active and roughly 4-10% will more than likely lead to an amputation of the limb. It is important to note that neuropathic wounds are likely to heal over a 20 week period whilst neuroischemic ulcers take longer and often lead to amputation.
Classification for Foot Ulcers: The Wagner Way
Remember when our mothers would tell us not to poke something with a stick? Well... you can ignore that because poking and prodding is essential when dealing with ulcers! (goes without saying, don't prod with any stick you find!) Below is a table on different classifications when dealing with wounds but I'll mainly expand on the Wagner classification system, which is more common.
Wagner Classification System:
As a first year podiatry student, you don't NEEEEEED to memorize Wagners grading method but it is important that you become familiar with it!
Interesting sites to check out if you'd like an in-depth explanation on diabetic foot ulcers,I've merely scratched the surface
1) Alexiadou, K., & Doupis, J. (2012). Management of diabetic foot ulcers. Diabetes therapy : research, treatment and education of diabetes and related disorders, 3(1), 4. https://doi.org/10.1007/s13300-012-0004-9
4) Karina, Wahyuningsih, K. A., Sobariah, S., Rosliana, I., Rosadi, I., Widyastuti, T., Afini, I., Wanandi, S. I., Soewondo, P., Wibowo, H., & Pawitan, J. A. (2019). Evaluation of platelet-rich plasma from diabetic donors shows increased platelet vascular endothelial growth factor release. Stem cell investigation, 6, 43. https://doi.org/10.21037/sci.2019.10.02
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