What is a diabetic foot ulcer?
The diabetic foot syndrome (DFS), colloquially called "diabetic foot", is a syndrome associated with diabetes mellitus, the patients with type 2 diabetes most often (so-called. Diabetes) occurs. The diabetic foot ulcers annually in Germany leads to approximately 40,000 amputations and is thus the cause of two thirds of all amputations performed.
Root cause
Circulatory disorders and wounds
The cause wounds come on foot or lower leg in question, do not heal spontaneously within two to three weeks. Causes are often circulatory disorders of the extremities or in the context of diabetes-related nerve damage (polyneuropathy) decreased pain perception. The wounds incurred in trivial accidents, by improper foot care, or already bumping the toes in the shoe or to edge.
The risk of suffering from a poorly healing wound, is particularly high in combination circulatory disorder. Deep skin ulcers (ulcers) can always be further extend into the foot and also colonized with MRSA germs that may prevent normal wound care and healing.
Charcot foot
Another cause is the destruction of bones and joints in the foot (Charcotfuß). A Charcotfuß (also DNOAP = diabetic neuropathic osteoarthropathy) arises in the context of polyneuropathy. If it comes to a break, the person does not feel it often through the polyneuropathy. Since no sensation of pain is present, many sufferers burden weeks the broken foot. The foot is warm, swollen and red in comparison to the contralateral side. The pain it will be lower than expected or may even fail completely despite significant fractures. Lead to the doctor as the striking deformity of the foot, resulting ulcers.
As a first therapy is done the complete discharge (bed rest), then the partial discharge eg in plaster casts, later special-made orthopedic shoes must be worn.
Signs of damage
The signs of injury may indicate nerve damage or circulation problems:
Nerve damage
-Numbness, burning, tingling in the toes and feet.
-The feeling of walking on cotton wool and the feeling of having cold feet, even though they are warm.
-Pain at rest feet, especially at night and pain relief by walking about or cooling.
-Joint swelling and strong tendency to callus and nail fungus.
-Reduction or loss of temperature and pain sensation
Circulatory disorders
-Cold feet
-Thin, parchment-like, bluish pale skin
-Pressure points (rötl. Macules, which can not be prune)
-Calf pain or cramps when walking - relief by stopping, colloquially called claudication.
Prevention
Preventive measures for prevention of the diabetic foot syndrome affect all people with diabetes and with impaired sensation or circulatory disorders.
General should value on a good skin care - also for monitoring of vulnerable parts of the body - are placed. To nail and callus care no sharp objects should be used (not by podiatrists), instead, nail files and pumice stones. Skin care ointments should not be applied in the spaces between the toes, but on the sole and dorsum of the foot. Athlete's foot is to be treated consistently and spaces between the toes dried thoroughly after bathing. The shoes must be sufficiently wide and soft and the feet are checked daily for injuries, including with a shaving mirror.
As measures for prevention are recommended
-Daily View the feet exactly and check for injuries and bruises. Check for swelling by painted by hand on the foot, even after wearing new shoes or after long walks / hikes check feet.
-Wash daily with lukewarm water. Not more than three minutes, dry thoroughly, especially in between the toes.
-Skin conditioner with urea-containing creams to avoid cracks (Rhagade / fissures). The cream must move well / dry, it may no residues between the toes.
-Only use files do not use rasps, nail clippers or scissors.
-Toenails spade-shaped (straight) shape with files, never cut - because of injury.
-Do not use corn plaster or tinctures, they may contain corrosive substances, which lead to injuries.
-Wear comfortable, loose and soft shoes, preferably leather, not rubber and sneakers because of perspiration. Daily before use hand control shoes on bumps or pebbles etc..
-Wear cotton socks without suppressing seam, change socks daily
-Expose feet to excessive heat, as occurs for example in electric blankets or fireplaces, there is risk of injury, no direct sunlight
-Be careful when walking barefoot, athlete's foot risk and risk of cuts and abrasions
Particularly in diabetic foot problems should seek help from a professional podiatrist, who specializes in the treatment of diabetic foot ulcers, are looking for. This treatment can be prescribed at the expense of the statutory health insurance by the physician under certain conditions.
Diabetic foot ulcer treatment
Depending on the severity of the injury and the stage of the patient should be properly cared for by a wound care team. Through the wound healing disorder treatment can pull over very long periods of time. In some cases, antibiotic therapy is long-term in addition to the regular wound care necessary. From Stage II inpatient care is necessary in individual cases.
The treatment can be based on the guidelines of the German Society for wound healing and wound treatment and the German Diabetes Society.
In wound care team working for optimal support depending on the case, different specialists, including:
-Doctors (general practitioner / internist / diabetologist / surgeon / vascular surgeon / orthopedist)
-Specialized professionals (therapists DGfW wound / wound Manager ICW)
-Orthotist
-Podiatrists
-Psychosocial support
Therapy orientation:
-National Disease Management Guideline (NVL) Type 2 diabetes: prevention and treatment strategies for foot complications of the German Medical Association, AWMF and KBV (AWMF guidelines register NVL 001 / c)
-S3-Guideline of the German Society for Wound Care (local therapy of chronic wounds in patients with the risks of peripheral arterial disease, diabetes mellitus, chronic venous insufficiency)
-Diagnosis, treatment, follow-up and prevention of diabetic foot ulcers, Guideline of the German Diabetes Society and the German Society for Vascular Surgery
Even under optimal conditions, there are many people with diabetic foot ulcers in long-term treatment and are often very limited in the activities of daily living.
Therapy methods
Cause fighting: By vascular surgical measures, such as a revascularization by bypass and by orthopedic surgery for the correction of abnormal positioning of the foot in diabetic osteoarthropathy to avoid the pressure points and bony prominences edges
Wound cleaning and debridement: Most surgical removal of devitalized tissue, necrosis, deposits and / or removal of foreign bodies up to intact anatomical structures zoom obtain granulation - mainly active periodic cleaning of the wound as directed recurring mechanical debridement as part of dressing change.
Associations: In a Cochrane review of Palfreyman evident in regard to wound healing, no statistically significant difference between hydrocolloids and gauze or dressings, alginates, foams, hydrocolloids or different manufacturers. A vacuum therapy is often used.
Physical interventions: To complement the conventional wound treatment are a number of different methods available, their goal is a more effective and faster wound healing, thereby reducing the very high amputation rate. In addition to many case reports, there are few good clinical trials demonstrating scientifically an actual effect of this method. Many methods have yet to be assessed as experimentally. An overview of the significance of the different treatment proposals can be found in the Guideline referred to S3. The following procedures are currently applied:
-Hyperbaric oxygen therapy as a pressure treatment of the whole body, which can be used after exhausting of Revaskularisationsmaßnahmen as an additional therapeutic option (After judgment of the Federal Social Court of 7 May 2013 (PDF, 23 kB) to ensure appropriate legally insured patients receive the reimbursement from their health insurance)
-Electrical stimulation therapy
-Shock wave therapy (ESWL)
-A low energy (low-level) laser light therapy
-Heat treatment with infrared radiators
-Ultrasound therapy