When you discover a diabetic foot ulcer, it's a scary situation. You suddenly notice a hole in the bottom of your foot. My name is Dr. Andrew Schneider and I'm a podiatrist in Houston, TX. A diabetic foot ulcer is important to address immediately. How you first treat a diabetic foot ulcer may dictate the speed in which it is going to heal. In today's video I'm going to discuss the first steps you should take when a diabetic foot ulcer is discovered.
I recommend that all of my diabetic patients begin a nightly routine of inspecting their feet. This is an essential way to make sure their feet stay healthy. What are you looking for during these inspections? You're looking for anything that wasn't there yesterday. For instance, be aware of any new callus, blister, erosion, sore area of bleeding or pus, and especially the start of a diabetic foot ulcer.
A diabetic foot ulcer, for lack of a better description, is a hole in the bottom of your foot. It can become infected. The infection can travel to the bone. This puts your foot at risk for amputation. My job is to prevent that from happening. That's why the first thing you do when you discover a diabetic foot ulcer is to contact your podiatrist.
In my practice, the discovery of a diabetic foot ulcer is a medical emergency. You call and say, "I'm diabetic. And I think I have a problem." and no matter what our day looks like we get you in. Once at the office, we'll do some assessments on the foot ulcer. We'll likely take an x-ray to make sure the bone isn't involved and to make sure there's no damaging gasses in the tissue. We may also do a circulation test to make sure you have enough blood flow to heal the ulcer. I'll remove the unhealthy tissue of the foot ulcer to be able to see it's true borders in depth. This is a process called debridement.
At this point. I'll have a good idea if the wound is infected or not. This is essential to be able to offer the proper treatment. Even if the wound is not infected, I may still prescribe a course of antibiotics to ensure you're clear of any infection. I may also swab the wound to send material to the lab, to check for infection as well.
Now it's time to decide how to start the wound on the path to healing. A common mistake I see is to either not dress the wound or to treat it like a cut. Sometimes you may be told just to put a topical antibiotic on it. Whether prescribed or over the counter, this is the wrong approach. We want to apply a wound dressing that will keep an ideal environment for the ulcer to heal. We also want to use dressing that will promote the tissue to heal. a topical antibiotic, or a cream such as Silvadene, do not meet these
criteria. The good news is that there are a tremendous number of wound care products on the market designed to heal your foot ulcer. Some of these wound dressings are topical gels or ointments that are easily applied to the wound at home. These are usually prescribed through your regular pharmacy.
There are other types of dressings that promote the healing of a diabetic foot ulcer. I change to these dressings. If I don't see the wound progressing to become closed, I don't like to see a wound stagnating. These dressings fall into three categories, Collagen, Alginates, and Foams.
Collagen is the most abundant protein in your body. It's involved with all aspects of wound healing. Using dressing embedded with collagen encourages the body to form new collagen fibers and support the growth of new tissue. Collagen dressings most often come in sheets and in powder form.
For wounds that may be draining, I'd consider using an alginate dressing. An alginate dressing is formed from seaweed and is capable of absorbing moisture. When moisture interacts with the dressing, it forms into a gel that supports the healing of the foot ulcer because it requires moisture to
be reactive. It's not used on dry wounds.
The final category of conventional wound products are foams. Foams are indicated for wounds that have even heavier drainage. Sometimes they're used as a primary dressing directly on the wound. Other times, they're used as a secondary dressing to absorb more moisture if necessary.
These are just the broad categories. Within each is a tremendous number of products that are available. There's no one-size-fits all solution for a diabetic foot ulcer. If these aren't providing results, there's more that can be done.