As diabetes is main cause of amputation proper care, therefore, is essential. In addition, providing ways for self-care to patients is the first primary prevention to protect them from having amputation as a treatment solution.
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- There are 20% of diabetic patients who stay in a hospital regarding foot ulcers.
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- The Diabetes causes 40 to 70 percent of amputation to the patients.
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- 85 percent of Diabetic patients has the foot ulcers.
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- In every 30 seconds, the patients will lose their feet due to the amputation.
- Diabetes patients have risk for the amputation 40 times higher than those not having the disease.
In 2003, there were 194 million people worldwide who have been diagnosed with the diabetes, which expected to rise to 333 million by 2025.
As people now live longer, numbers of the patients then increases. Lack of exercise or having unhealthy foods in regard of diabetes patient behavior will also be raised including case of complications such as foot ulcer. Proper foot care together with self-care advised by a specialized doctor can prevent the patients from amputation. The advice consists of the following topics:
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- Ways for Prevention
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- Integrated Wound Care Treatment
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- What is the best sanatorium?
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- Follow-up Plan
- Advice for diabetics patients and family
Combination of mentioned approach predicted as a key for decreasing rate of amputation in diabetic patients by 49-85 percent
Approximately 6.3 of world population has the diabetes, each year there are more than 3 million people died of the disease and recently the disease is listed as one of the top of death cause disease in developed countries.
Diabetes and Foot
Diabetes patients are at risk of developing dementia (Neurologic complications) and Ischemia where the blood cannot support to the feet. Both conditions derive from the foot ulcers that are infected; patient may end up with amputation.
Foot ulcers Leads to Amputation
Generally, the disease contributes to the foot ulcer which is why many cases must encounter with an impact (foot ulcer) Statically, 5 percent of many developed countries found that most of the patients with the disease have foot ulcer. In every 6 people there is one diabetic patient who at least used to have the foot ulcer.
Half numbers of the patients have diabetes however; there are other factors, such as race, climate change and social environment that increase the risk of foot ulcer. At the same time, the amputation has become significant treatment for the diabetic patients.
For those who lose legs are amputated may have to face with financial problem and bad living.
Foot Care
Taking a good care of the feet can prevent the foot ulcer. Most of patients with diabetes cannot avoid the amputation but they can take care of inoperative foot.
Preventing Amputation
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- Learning about observation to detect foot problems from the beginning.
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- Emergency services
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- Infection screening and early treatment
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- Health Control
- Wound care by specialists
Foot ulcers in diabetic patients can cause major problems as it makes you stay longer in a hospital, receive physical therapy and also requires special good care at home which is costly.
What is the cause of foot ulcers in diabetes?
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- Nerve Damage (Peripheral neuropathy)
Patients will not feel hurt due to numbness which may lead to infectious foot ulcer especially in those wearing uncomfortable shoes.
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- Feet and Toes Deformed
Normally, people have different foot shape and it will continue changing when we get older or the shape could be deformed due to inappropriate shoes or after undergo a surgery including complication in the nerve or wart.
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- Infection
When the skin is cracked, bacteria surrounds outside may enter to cause the infection. The wound then is hard to be healed and sometimes the infection is quite severe.
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- Infarction (Complications of diabetic peripheral vascular disease)
If the blood is not sent to the foot the ulcer may take longer time for recover as the organs need a support from oxygen, moreover, the infarction can make the skin darker and dead.
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- Injury
Patients with degenerative nerve will not feel pain, which this is dangerous sign as foreign things inside or outside shoes, when patients step on them and penetrate to the foot including being burnt by hot water, all cannot send the pain to the areas and it can cause complication, infection to the ulcers.
Prevention of Foot Ulcer
Good foot care can prevent ulcers and foot injuries by 45-85 percent. For those having blood deficiency or infarction should follow the instruction below:
What Require in The Patient
- Daily foot observation such as scratches, blisters, bruises, or skin tones. Moreover, swelling and ulcers also need to be observed, you can ask someone for assisting some areas you might not be able to see.
- Wash your feet with soap and water every day then dry them carefully. Apply oil or lotion on the feet to soften the skin. Please avoid the toe area.
- Check the shoes before wearing to eliminate foreign matter particularly stones, sharp objects.
- Wear socks to prevent the skin from irritating or touching. The socks should not be too tight or have holes.
- You should choose a new pair of shoes during afternoon to let the feet expand fully and select the right size regarding the foot.
- Foot check by a health care team.
- Cut the foot nail in straight line angle then sharp it with rasp
- Clean the ulcers with sterile material.
- Be careful while wearing shoes to avoid dangers to the feet.
What to avoid
- Avoid high heel
- Do not wear tight socks
- Do not pad hot water bag on the feet
- Avoid having bare feet or walking on hot surface
- Avoid using razor, rasp to wart, consult a doctor for proper care.
- Control body weight
- Avoid smoking as the blood vessels do not supply the feet fully
- Do not wear ornaments on the feet.
Treatment of diabetic foot ulcers
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- Avoid weighing the body on the feet while walking
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- Treat the infarction of the feet probably
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- Treatment of Infection
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- Control blood sugar, lipids, and blood pressure.
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- Wound ulcer cleaning including biopsy
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- Consult and explain patients and family about the disease for more effective result
- Detect the cause of ulcer and prevent its repetition.
Article by DR.POONPONG HUTACHOKE
Specialized Doctor in General Medicine,
Endocrinology and Metabolism
Diabetes and Endocrinology Center, Building A
Tel: +662-617-2444 ext. 4703, 4705.
