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Monthly Archives: April 2014

Ulcers

What is a diabetic foot ulcer?

A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, 6 percent will be hospitalised due to infection or other ulcer-related complication.

Diabetes is the leading cause of non-traumatic lower extremity amputations in the United States, and approximately 14-24 percent of patients with diabetes who develop a foot ulcer will require an amputation. Foot ulceration precedes 85 percent of diabetes-related amputations. Research has shown, however, that development of a foot ulcer is preventable.

Causes:

Anyone who has diabetes can develop a foot ulcer. People who use insulin are at higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers.

Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation and trauma. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of ability to feel pain in the feet due to nerve damage caused by elevated blood glucose levels over time. The never damage often can occur without pain, and one may not even be aware of the problem.

Vascular disease can complicate a foot ulcer, reducing the body’s ability to heal and increasing the risk for an infection. Elevations in blood glucose can reduce the body’s ability to fight off a potential infection and also slow healing.

Symptoms:

Pain is not a common symptom as many people who develop foot ulcers have lost the ability to feel pain. The first thing you may notice is some drainage on your socks. Redness and swelling may also be associated with the ulceration and, if it has progressed significantly, odour may be present.

Diagnosis and Treatment:

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.

There are several key factors in the appropriate treatment of a diabetic foot ulcer:

– Prevention of infection
– Taking the pressure off the area
– Removing dead skin and tissue
– Applying medication or dressings to the ulcer
– Managing blood glucose and other health problems

To keep an ulcer from becoming infected, it is important to:

– Keep blood glucose levels under tight control
– Keep the ulcer clean and bandaged
– Cleanse the wound daily, using a wound dressing or bandage
– Avoid walking barefoot

For a wound to heal, there must be adequate circulation to the ulcerated area.

Prevention:

The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing a podiatrist on a regular basis. Your podiatrist can determine if you are at high risk for developing a foot ulcer and implement strategies for prevention.

You are at high risk if you have or do the following:

– Neuropathy
– Poor circulation
– A foot deformity
– Wear inappropriate shoes
– Uncontrolled blood sugar
– History of a previous foot ulceration

Reducing additional risk factors, such as smoking, drinking alcohol, high cholesterol and elevated blood glucose, are important in prevention and treatment of a diabetic foot ulcer.

Wearing appropriate shoes and socks will go a long way in reducing risks. Your podiatrist can provide guidance in selecting the proper shoes.

Learning how to check your feet is crucial so that you can find a potential problem are early as possible. Inspect your feet every day – especially the sole and between the toes – for cuts, bruises, cracks, blisters, redness, ulcers and any sign of abnormality.

The key to successful wound healing is regular podiatric medical care to ensure an optimum standard of care:

-Lowering blood sugar
– Appropriate debridement of wounds
– Treating and infection
– Reducing friction and pressure
– Restoring adequate blood flow

 

 

Plantar Warts

Sometimes painful and very ugly, plantar warts appear as small lesions on the sole of the foot and occasionally on the toes. In their early stages they appear as small black puncture marks, but as they grow they turn brown and take on a cauliflower-like appearance. A black spot may develop in the middle, which is caused by bleeding. Plantar warts are pushed deep into the skin by the weight of your body as you walk, which is why they can hurt a lot.

The Human Papillomavirus (HPV) strains that are most often the cause of plantar warts are type 1 & 2 HPV. These strains are contagious and are spread from person to person via direct contact with the virus. The HPV that causes plantar warts thrives in warm, moist environments such as shower rooms and summer pool decks.

Sometimes a group of small plantar warts develop in one spot on the foot. The smaller warts then form a plaque-like covering. These warts are called mosaic warts because of the mosaic look on the plaques.

Symptoms

Unless feet are checked regularly, the first time a person is aware of plantar warts is pain when walking. Then on checking their soles they may notice an unusual rough crusty lump that feels tender and sore. Plantar warts re sometimes mistaken for corns and calluses but there are several difference to look out for when trying to determine if you have a plantar wart or something else. Plantar warts have one or more black pinpoints within the growth. These pinpoints are actually clotted blood vessels. Calluses are smooth and clear. Plantar warts also have well defined boundaries and rough surfaces where calluses are less defined around the edges and have much smoother surfaces.

Causes

These uncomfortable growths are caused by the Human Papilloma Virus (HPV) which thrives on warm, moist surfaces such as those found in swimming pools, locker rooms and bathrooms. It is a highly contagious pathogen and can survive for several months without a human host. The only way to catch the HPV is by direct contact, and the viral route into you is through cuts, abrasions and other skin breaks on your feet. If an infected person walks barefoot on a floor, virus particles may be released which you could catch by walking across the same surface. Its also possible to become infected by using a towel of a person with plantar warts.

Treatments

If you have plantar warts there is absolutely nothing to be worried about, even though they can be painful. They are benign non-cancerous growths and there is a range of treatments on offer to eradicate them. Many Plantar warts disappear after a few months or years, and doctors recommend that you should seek help only if they are painful. However, they present a tough challenge to the medical profession as evidence shows that there is no single therapy that is capable of bring about complete remission from plantar warts in every patient.

Plantar warts can be eradicated by salicylic acid which is available from drug stores. Applied daily to the troubled area, the solution break down viral cells and can lead to wart removal in about four weeks.

 

The Effects Of Diabetes On The Feet

Foot care is particularly important if you have diabetes. Foot problems are a common complication of this condition. Your feet can be affected in two ways. Blood supply maybe be affected, resulting in slower healing. You may also lose some feeling in your feet due to nerve damage. A person who’s nerves are damaged by diabetes may not realise they have minor cuts or blisters, which can lead to ulcers.

Foot problems can be avoided if you take care of your feet and act quickly when you have a problem. Get your feet checked at least once a year by a doctor or podiatrist to detect problems early and help prevent complications.

Circulation in people with diabetes

Poor blood circulation can affect the blood supply to your feet. When this is reduced, cuts and sores may not heal. An early sign of poor circulation to the feet may be pain or cramps in the backs of your legs when walking.

Circulation problems can be caused by hardening or narrowing of arteries as they become clogged up. Common causes include:

– Smoking

– High Blood Fats

– Raised blood glucose levels

Suggestions to improve blood circulation include:

– Control your blood fat levels

– Keep blood glucose levels a close to normal as possible

– Don’t smoke. Smoking causes spasm and narrowing of the blood vessels. Smokers have more hear attacks, strokes and circulation problems than non-smokers.

– Exercise daily, a brisk walk will help keep the blood flowing around your body.

Foot care for diabetes

All people with diabetes should have their feet checked at least once a year by a doctor or podiatrist. This is important to detect problems early and to prevent ulcers and other complications. You may have heard it said that diabetes causes gangrene (dead, black tissue). Most cases of gangrene result from delayed treatment of foot injuries.

Daily foot care for people with diabetes:

-Check you feet daily for signs of swelling, redness or heat – these may be signs of infection

– Wash your feet daily and dry well between the toes

– Use  methylated spirits if there is a lot of moisture between the toes.

– Moisturise dry skin, especially cracked heels (for example, with sorbolene cream) but not between the toes.

Nerve Supply to the feet

Nerves are the ‘wiring’ of the body. They carry messages to your brain from the rest of your body. The nerves of your feet are most likely to be affected by diabetes.

Damaged nerves (neuropathy) can cause painful, numb or insensitive feet. Minor cuts, blisters or burns may not be felt and ulcers can develop, which you may not be aware of. Some people with neuropathy experience uncomfortable sensation such a burning, tingling and pain, it is often worse at night.

How to avoid injury to feet with damaged nerves:

– Never go barefoot

– Wear appropriate shoes to protect your feet.

– Avoid injury by wearing well-fitting, protective shoes – do not wear open toed shoes.

– Keep toenails trimmed. Cut toenails along the shape of the toe and file rough edges.

– Have corns and calluses treated by a podiatrist.

– Check the temperature of your bath water with your elbow before stepping into the bath.

– Be careful  not to put your feet too close to radiant heaters.

– Every six months, check for signs and symptoms that may indicate you have a foot problem. These may include reduced circulation or sensations, abnormal foot structure or poor hygiene.

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