Neuropathic ulcers, often caused by diabetes, are slow to heal—even more so as patients age, if they have longer-term diabetes, or if they’re smokers. Other factors that may stall healing include hypertension, hypercholesterolemia, and abnormal blood sugar levels, often associated with diabetes.
Diabetic ulcers typically occur below the ankle at any site of pressure, friction, shear, or trauma. The wound is likely to be round, with margins often characterized by a periwound callus. The presence of diabetes increases the risk for infection.
Treating neuropathic/diabetic ulcers can be challenging, so be sure to take the following steps to simplify the process and help improve outcomes:
1 | Remove pressure
Take any undue pressure away from the foot by using total contact casting, therapeutic boots, specialty footwear, and off-loading devices.
2 | Debride the area
When appropriate, perform radical local debridement of the callus, tissue, and bone.
3 | Keep the foot clean and dry
Soaking, whirlpool, or other hydrotherapies are not recommended, as they can lead to maceration, mild burns, or infection.
4 | Moisturize the area
To maintain and regain skin health, moisturize the leg to the wound margin. If the arterial perfusion is adequate to support moist wound healing, then treat the wound with a dressing that promotes optimal moisture. If the wound is dry, apply a product that donates moisture or supports what moisture is already present. If the wound is moderately to heavily draining, choose a dressing that absorbs excess drainage. This will bring the moisture level back into balance.
5 | Improve circulation
People with diabetes often experience reduced blood flow to the skin. Improve circulation with vascular bypass, percutaneous angioplasty, laser treatment, and hemorrhagic agents like Trental (pentoxifylline). A vascular assessment includes arteriography to assess the level of blood flow and determine if vascular reconstruction is appropriate. This can lead to increased healing, elimination of pain, improved function and overall increased well-being.
6 | Use adjunctive medical therapies
These should not be overlooked. Beneficial modalities include normalizing blood glucose (macrophages perform less efficiently if blood glucose is greater than 180), treating edema, providing for nutritional therapy, and controlling comorbid conditions. By addressing these 6 areas, treating diabetic foot ulcers can quickly go from a complex endeavor to a much less intimidating situation for you as well as your patient.