Diabetic Wound Care Management

Sandhya. P

Diabetes Educator, Kauvery Hospital, Alwarpet, Chennai, Tamil Nadu

Introduction

Diabetic wound management focuses on preventing complications, promoting healing, and addressing infection in wounds that develop due to diabetes. Key aspects include proper wound cleaning, offloading pressure, infection control, and managing blood sugar levels.

Risk for Diabetic Foot

  • DM > 10 years
  • Peripheral Neuropathy
  • Abnormal Foot structure
  • Peripheral arterial disease
  • Ischemia in foot
  • Callus
  • Inappropriate foot wear
  • Smoking
  • Poor glycemic control (HbA1c > 7%)

Diabetic Foot Complications

  • Diabetic foot ulcers – open wounds on the feet are common in patients with uncontrolled blood sugar level.
  • Foot ulcers develop when the skin is exposed to repetitive pressure on the bottom of the foot, or from friction from poorly fitting shoes.
  • Two of the most common disease processes that affect the feet in people with diabetes are diabetic peripheral sensory neuropathy and peripheral arterial disease.
  • Peripheral arterial disease involves damage to the medium and small arteries that supply blood and oxygen to nourish foot tissue.
  • Peripheral sensory neuropathy affects more than half of people with diabetes. Neuropathy damages the nerves in the feet, so people experience numbness or tingling, or feel like they have a heavy stocking or sponge on their foot.
  • Diabetic ulcers can become non healing wounds that persist for months or even years.

Stages of Foot Ulcer

Grade 1: Ulcers are superficial, have a full thickness and are limited to the dermis.

Grade 2: Ulcers extend through the sub cutis

Grade 3: Ulcers involve bone infection, displaying destruction of the periosteum and cortex

Causes of Diabetic Foot Ulcer

Foot Care Team

Complex, severe, or recurrent diabetic foot ulcers require a higher level of care.

  • Diabetology: To bring the glycemic levels under control
  • Plastic Surgery: Skin grafts for persistent or non-healing ulcers
  • Podiatric Surgery: To correct foot deformities, such as high arches or flat feet
  • Vascular Surgery: To reduce the risk of developing new or recurring ulcers

Diabetic Foot Care Procedures

  • Debridementto remove dead or infected skin and tissue from the wound, which encourages healing.
  • Skin graftsto reconstruct weakened or missing skin, which promotes healing and helps reduce the risk of infection. Skin can be taken from another part of the patient’s body, such as the thigh, or come from a donor; it depends on each individual.
  • Vascular surgery, which helps restore proper blood flow to the wound site, promoting healing and healthier skin.
  • Shaving or removing boneto correct deformities that put pressure on the surrounding area, such as hammertoes and bone spurs.
  • Reconstructionof deformities such as flat or high-arched feet, which can cause areas of high pressure.
  • Realigning or fusing jointsto address biomechanical defects that increase pressure
  • Lengthening tendonsto release tension and take pressure off an ulcer, allowing it to heal, or prevent a new one from forming.
  • Amputationof a toe or the foot if tissue is severely damaged or an infection will not stop spreading. Our podiatric team exhausts all other options before recommending amputation.
  • Inspect your feet daily. Check for cuts, blisters, redness, swelling or nail problems. Use a magnifying hand mirror to look at the bottom of your feet. Call your doctor if you notice anything.
  • Bathe feet in lukewarm, never hot, water. Keep your feet clean by washing them daily. Use onlylukewarm water.

Diabetic foot care Management

  • Be gentle when bathing your feet.Wash them using a soft washcloth or sponge. Dry by blotting or patting and carefully dry between the toes.
  • Moisturize your feet but not between your toes. Use a moisturizer daily to keep dry skin from itching or cracking. But don’t moisturize between the toes—that could encourage a fungal infection.
  • Cut nails carefully.Cut them straight across and file the edges. Don’t cut nails too short, as this could lead to ingrown toenails. If you have concerns about your nails, consult your doctor.
  • Never treat corns or calluses yourself.No “bathroom surgery” or medicated pads. Visit your doctor for appropriate treatment. Wear clean, dry socks. Change them daily.
  • Consider socks made specifically for patients living with diabetes.These socks have extra cushioning, do not have elastic tops, are higher than the ankle and are made from fibres that wick moisture away from the skin.
  • Wear socks to bed. If your feet get cold at night, wear socks. Never use a heating pad or a hot water bottle.
  • Shake out your shoes and feel the inside before wearing.Remember, your feet may not be able to feel a pebble or other foreign object, so always inspect your shoes before putting them on.
  • Keep your feet warm and dry. Don’t let your feet get wet in snow or rain. Wear warm socks and shoes in winter.
  • Consider using an antiperspirant on the soles of your feet. This is helpful if you have excessive sweating of the feet.
  • Never walk barefoot.Not even at home! Always wear shoes or slippers. You could step on something and get a scratch or cut.
  • Take care of your diabetes.Keep your blood sugar levels under control.
  • Do not smoke. Smoking restricts blood flow in your feet.
  • Get periodic foot exams.Seeing your foot and ankle surgeon on a regular basis can help prevent the foot complications of diabetes.

Diabetic Wound care Management

Cleaning

  • Clean the wound regularly
  • Avoid using Betadine or other iodine-based products, which can damage human cells

Bandaging

  • Use a dressing that’s appropriate for the type of wound
  • Change the dressing when needed
  • Avoid filling the wound with too much dressing

Monitoring blood sugar

  • Keep blood sugar levels under control to help the body fight infection and heal faster
  • Manage other health problems like high cholesterol and high blood pressure

Reducing pressure

  • Avoid walking barefoot
  • Wear special shoes, braces, or casts to reduce pressure on the wound
  • Break in new shoes slowly

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