Breaking myths about Diabetic foot ulcers

CHENNAI: Diabetic foot ulcers are not exclusive to the elderly. While they often manifest in individuals with long-standing and uncontrolled diabetes who neglect proper foot care, even younger individuals with juvenile diabetes can be susceptible if left untreated. Prolonged increased blood sugar levels, a hallmark of the condition, may predispose individuals to the development of diabetic foot ulcers.

High blood sugar levels gradually affect both large and small blood vessels, diminishing blood delivery to tissues and compromising immunity. Simultaneously, nerve changes reduce sensations, making individuals unaware of minor injuries. Alterations in bones, ligaments, and connective tissues in the feet lead to biomechanical imbalances, rendering joints unstable and causing shifts in pressure points on the soles of the feet.

This results in the formation of cavities between bone and skin, which, when exposed to trivial injuries or thorn pricks, rapidly worsen into significant wounds. Diabetic ulcers, therefore, are multifactorial, developing over time and erupting suddenly due to minor injuries.

It is a misconception that all diabetic patients will inevitably experience foot ulcers. Those with diabetes for over 10 years face an increased risk of developing the changes that lead to ulcer formation. Precautions must be taken to prevent these ulcers, such as avoiding walking barefoot, using protective-padded socks, and regularly examining the feet for any signs of damage.

Proper moisturisation and customised insoles or shoe bases are essential for maintaining skin pliability and reducing the risk of ulcers. Periodic foot scans can help identify abnormal pressure points and skin thickening, ensuring effective preventive measures.

Contrary to the belief that amputation is the only solution, diabetic foot surgeries have evolved from traditional ‘debridement and amputations’ to focus on limb salvage and rehabilitation. From addressing biomechanical issues before ulcers form to employing microvascular techniques for extensive wound reconstruction, these surgeries aim at preserving limbs and facilitating rehabilitation.

Consulting a plastic surgeon early in the process is crucial, as diabetic foot management involves prevention, optimisation, reconstruction, and rehabilitation. The ultimate goal is to enable patients to walk independently and resume their daily routines as soon as possible.