Treatments for Diabetic Foot Ulcers

Due to the various combinations of potential risk factors, ulcers in diabetic patients are unfortunately very common. High-risk patients include those with poor circulation and those with decreased sensation from peripheral neuropathy, and ulcerations tend to result in additional complications including infections and amputations. In fact, 85 percent of diabetes-related amputations are preceded by an ulercation, which makes the management and treatment of foot and leg ulcers a critical component of limb loss prevention.

Prevention & Treatment of Diabetic Ulcers

As a foot care nurse, it's important to be aware of the risk factors for ulcerations, and how you can help your patients prevent serious secondary complications as a result.

Controlling Blood Sugar

Although as a foot care nurse your specialty is not in nutritional counseling, helping patients understand the importance of maintaining healthy blood sugar levels cannot be understated. Because uncontrolled high blood sugar damages nerves and blood vessels, reiterating proper nutrition can help patients to understand that diabetes is a multi-faceted problem that requires more than one targeted approach.

The Right Footwear for Diabetic Feet

Since ulcerations result from pressure points, the right shoes are critical for diabetic patients. We see many patients who are in the wrong foot wear, partially due to under-education and partially because extra-depth shoes may not be covered by insurance, and are therefore a cost-restrictive solution that patients end up unfortunately foregoing.
For patients who are at risk for developing pressure points from shoes, a wide tennis shoe with a foam or plastazote bilayer insole is an affordable alternative that's suitable for most.
Risk factors for developing ulcers from regular shoes increase in diabetic patients who have hammertoes, corns, calluses or bunions. These risks can be mitigated with appropriate footwear and pressure relief pads and control aids, which can be applied easily and worn daily.

Recommendations:

• Shoes with roomy toe box
• Reusable callus cushions
• Lambs wool to reduce friction
• Hammertoe corrective pads

Applications of Debridement for Diabetic patients

One of the skills we focus on growing the most at Rainier Medical Education is debridement. Our hands-on training courses are designed to get you comfortable using various sanding tools and identifying which sanding bits you prefer in practice, as well as proper toenail clipping and safe removal of corns, calluses and more. Additionally, we offer regular foot and wound care conferences, which include three hours of detailed hands-on sharp wound debridement, equal to three continuing education credit hours for nurses.
Debridement is a critical component of diabetic and elderly foot care because it improves healing and reduces the risks of further complications. During conservative sharp debridement, dead, damaged or hyperkeratosic tissues are removed to prevent further damage and minimize the risk of infection. During corn, callus and toenail debridement, we aim to significantly reduce friction and pressure points that result in blisters, ulcerations and infection.

Medications and Dressings to Manage Ulcers

Unless an ulcer has developed gangrene, ulcers heal more quickly in moist environments. An Unna's boot is specifically designed to address excess fluid in the lower extremities and to help increase blood flow, which encourages wounds to heal. An Unna's boot bandage such as this one containing zinc oxide paste will reduce inflammation, help regrow healthy tissue faster and significantly reduce skin breakdown and further infection. An Unna's boot is an ideal first choice for ambulatory patients who have developed lower extremity ulcers.

Offloading for Ulcer Treatment

While not an ideal solution for all patients, keeping all the weight off the affected leg when an ulcer develops is extremely important for the healing of plantar ulcers. Offloading ensures that the affected leg does not suffer from inhibited blood flow, which will ultimately hinder the healing process. Unlike some other methods, offloading is designed to speed up the healing process in order to reduce the occurrence of additional complications such as infections.

Total Contact Cast for Diabetic Patients

What is it

The total contact cast is a non-removable offloading device that's made to cover and support the affected limb.

How does it work

The cast's contact design and soft layer of foam positioned directly under the ulcer keeps the patient's weight distributed evenly in order to eliminate pressure points. It addresses three of the critical components of ulceration treatment: proper vascular supply, infection prevention and plantar pressure redistribution. Patients who wear the cast oftentimes see improvement within 6-8 weeks, and complete closure in most wounds by 12 weeks.

Who is the cast for

The total contact cast isn't appropriate for all types of foot ulcers. In order for the patient to qualify, the ulcer should be:

• The result of a loss of peripheral sensation
• Not caused by poor perfusion
• Not infected

Effectiveness of a total contact cast

Although there's no single treatment that's suitable for every patient and decisions should be made on an individual basis, it's important to consider that lower leg ulcers do continue to be the leading cause of non-traumatic lower limb amputation in the U.S. Therefore, for the vast majority of patients, the benefits of total contact casts will outweigh the risks involved.
A total contact cast restricts ankle motion, reduces stride length and reduces plantar pressure in the metatarsal heads and forefoot. Studies have shown that most patients with noninfected, pure neuropathic ulcers can heal in a relatively short time when a total contact cast is applied.

Diabetic foot ulcers have lead to an increasing number of lower extremity amputations among patients in the United States in recent years. And a steady incline of an aging population whose citizens are living longer but also developing more health-related complications means nurses with foot care certifications are more essential than ever. Both private small clinics and hospitals need nurses who can provide preventative care for seniors and diabetic patients' feet.