DIABETIC FOOT CARE
When diabetes is not well controlled , damage to the nerves and blood vessels can occur over time. With damage to the nervous system a person may not be able to feel his or her feet properly. Normal sweat secretion and oil production that lubricate the skin of the foot is impaired and can lead to abnormal pressure on the skin or bones of the foot and can lead to ulcers.
Damage to the blood vessels and impairment of the immune system due to diabetes make it difficult to heal these wounds.
Therefore people with diabetes must be fully aware of how to prevent foot problems before they occur, to recognize problems early and seek medical advise when problems occur. Prevention remains the best way to avoid diabetic foot complications.
Diabetic Foot Causes
Several risk factors increase a person’s chance of developing foot problems and infections in the legs and feet.
Consult the doctor for any of the following symptoms
- Pain in the legs that increases with walking but improves with rest (intermittent claudication)
- Redness or swelling of the foot or leg
- Localized warmth
- Persistent pain in the legs or foot
- Numbness or feet
- Any significant trauma (injury) to feet or legs
- Any new blister, wound or ulcer in the legs or feet
Walking is the best exercise if you have diabetes Daily walking encourages the other smaller arteries to enlarge and improve the blood supply. If you walk regularly the symptoms will improve and the distance that you can walk before pain develops will increase.
Walk until the pain develops, then rest for a few minutes and carry on walking when the pain has reduced. Keep this for at least 30-45 minutes every day.
Management of diabetic foot
The most important part of the treatment of diabetic foot problems are the self help measures given below. If you smoke, stopping smoking is the single most effective treatment. Stopping smoking increases walking distance by two to three fold in 8 out of 10 patients with diabetes.
BLOOD PRESSURE levels must be maintained at normal levels.
Surgery for diabetic foot problems
Most people with diabetic foot problems do not need surgery. Surgery is considered as a last resort.
ANGIOPLASTY in which a tiny balloon is inserted into the artery and blown up at the section that is narrowed.
This widens the affected segment of an artery. Sometimes a peripheral sent may also be used.
is where a graft is connected to the artery above and below the narrowed section. The blood is then diverted around the narrowed section.
USE OF ARTERIAL FLOW PLUMPS IN DIABETIC FOOT PATIENTS
Arterial flow pumps have been shown to accelerate healing of ulcerative wounds and preserve limbs. They are used in patients with peripheral vascular disease, limb salvage, intermittent claudication and critical limb ischemia.
Arterial flow pumps are designed to augment arterial blood flow and microcirculation, and hence is useful in accelerating healing of ulcerative wounds and preserving limbs.
INDICATIONS FOR USE
Perpheral arterial diseases
Critical limb ischemia
The arterial pump increases the blood flow in the popliteal artery and at the tissue level. The pump has to be used for 2hours two to three times per day for optional results. The above picture shows the results after using the arterial pump for three months.
CELL THERAPIES IN TREATMENT OF CRITICAL LIMB ISCHEMIA AND DIABETIC FOOT ULCERS.
50% OF THE DIABETICS (7% OF THE POPULATION) SUFFER FROM PERIPHERAL VASCULAR OCCLUSIVE DISEASE,WHICH MAY LEAD TO AMPUTATION DUE TO CRITICAL LIMB ISCHEMIA.
Standard treatment of chronic wounds, and especially those secondary to CLI, includes surgical revasularization (distal crural or pedal bypass), endovascular therapy (recanalization by percutaneous transluminal angioplasty), cutaneous ulcers, maximum podiatric wound care (hyperbaric oxygen, antibiotics, vasodilators). The introduction of novel experimental therapies using recombinant growth factor therapy combined with tissue grafting has shown minimal benefit over standard treatment. In this therapy bone marrow is aspirated from the patients body and proginator cells (stem cells) are separated using various techniques and injected into the diseased leg or into the diabetic foot ulcers. The stem cells extracted from the bone marrow causes the growth of new blood vessels and tissues required for wound healing.
Representative photographs of limb ulcers before and 90 days after ABMSC therapy.
During 90days after ABMSC therapy all ulcers associated with CLI healed in those patients
(100%)with normal lymphocyte and thrombocyte counts in BMC at the time of procedure.
Representative angiography of limbs before and 120days after the ABMSC therapy. Follow up angiography reveals clear areas of neovascularization and collateral vesselformation along the calf vessels at the day 120 following administration of ABMSCs. The images correspond to the patients presented in Figure with healed wounds.