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When you think of an ulcer, you may immediately think of a stomach ulcer. When I think of an ulcer, my first thought goes to a diabetic foot ulcer. Both are similar. The stomach ulcer is a hole in the lining of the stomach. A diabetic foot ulcer is a hole in the skin and soft tissue on the bottom of the foot. My name is Dr. Andrew Schneider, and I'm a podiatrist in Houston, Texas.
A diabetic ulcer is a serious and potentially devastating complication of diabetes. In fact, my goal in treating patients with diabetes is to ensure that a diabetic foot ulcer does not form. A diabetic foot ulcer is an open sore often on the bottom of the foot that does not heal well. People with diabetes are more likely to develop foot ulcers. This is because of the nerve damage called peripheral neuropathy and poor circulation that diabetics experience. The poor sensation does not let you feel the pain from excessive pressure on the bottom of your foot. The poor circulation allows the skin to break down and form the ulcer. Both are responsible for difficulty in healing a diabetic foot ulcer. Diabetic foot ulcers are dangerous. They can lead to infection which can extend into the bone. They also can lead to the death to the soft tissue called gangrene. Sometimes an infection or gangrene needs to be treated by amputating a toe, part of the foot, or sometime the entire foot to prevent it from spreading and causing a serious systemic infection.
When you notice a diabetic foot ulcer, you may want to treat it like any other cut, but this is very different. Where you may use hydrogen peroxide or alcohol to clean a cut, those solutions are very harmful for an ulceration. While they do kill the bacteria in the wound, they also harm the cells that are responsible to heal the wound. These are common ways to treat an ulcer, but they're not very effective. They may prevent infection, but it's not providing what an ulcer needs to heal completely.
When you come into the office with a diabetic foot ulcer, I need to assess it in a number of ways. I'll measure the dimensions of the wound to serve as a reference to assess healing. I'll look at the depth of the wound to make sure it's not approaching the underlying bone. I'll also assess if your blood flow is good enough and whether or not the wound is infected. My first priority is to address any infection. It is essential to ensure that any infection is treated. Otherwise it will be an impediment to healing the foot ulcer. I'll then perform a debridement of the wound. That's a procedure that's done in the office where I remove any devitalized tissue that will get in the way of the wound healing. This is an important procedure that will be repeated regularly. I usually debride the wound at least every two weeks.
It's then time to determine what's the best wound dressing to get your wounds healed as quickly as well possible. Here, there are no shortage of choices. I can use an ointment that uses an enzyme to keep the unhealthy tissue away from the wound. Another ointment has growth factors in it to promote healing. There are wound dressings that are composed of collagen, which also promote healing. Other dressings are composed of alginates or foam to absorb any drainage coming from the wound. There are also specialty dressings. These are skin graft type dressings that serve as a biological dressing to the wound. Others use donated amniotic membranes to promote healing. I lately have been using a technology called Actigraft where we draw your own blood in the office and inject it into a mold that contains clotting factors. It clots and creates a biological dressing using your blood and your growth factors. The results have been phenomenal.
There are so many other dressings and modalities that can be used to heal a diabetic foot ulcer. That's because none of them are one size fits all. Each solution is tailored to each individual circumstances and the wound's properties. The other side of the coin, when it comes to healing, a diabetic foot ulcer is taking the pressure off of the wound after all it was pressure that caused the ulcer in the first place. This can be done using a surgical shoe, a fracture boot, a total contact cast, crutches, or a knee scooter. The pressure that you take off the wound is as important, if not more important, than what you put on the wound.