Diabetic Foot Ulcer

Poor granulation formation, prolonged abscess presence and impaired wound healing are further complicating the diabetic foot ulcer. Once the skin has been breached, continued mobilization on a broken area impairs the healing process. Inevitably, direct contiguous spread of microbes on the skin follows on, with colonization and infection of superficial and then deeper tissues is likely if the process is allowed to proceed unchecked. Both the healing process and the response to infection are further compromised by vascular insufficiency, which is commonly present in patients burdened with complications of diabetes [122]. The infection in diabetic foot is mainly by aerobic bacteria [88, 89, 102, 114, 123-125]. Anaerobic bacterial infection also plays a significant role in the infection of DFU but this has not been studied since the strict anaerobic culture techniques are not available at all the clinical laboratories. The impact of anaerobes was reported first by Louie et al., [126] and subsequently by many researchers [88, 89, 123, 125, 127, 128]. There are only few reports available on the incidence of fungal pathogens in diabetic foot infections [129, 130-132]. DFU infection is usually polymicrobial in nature and this was first reported by Louie et al., [126], and subsequently by many [88, 89, 102, 114, 124, 125]. The unique anatomy of the foot is the main reason that infection is potentially serious in this location [133]. The structure compartment, tendons, sheaths, and neurovascular bundles tend to favour the proximal spread of infection. The deep planter spaces were divided into medial, central, and lateral compartments. The infections may spread from one compartment to another at their calcaneal or by direct performation of septae, but lateral or dorsal spread is a late sign on infection [134].

The callus around a diabetic foot ulcer increases pressure to the area by about 27%. A qualified registered nurse or your doctor will need to remove this with a scalpel as often as needed. IF your orthotic device is effective, and you are wearing it, the amount of callus that occurs should decrease. This is why pressure “off-loading” must be done in order for the ulcer to heal. A consultation will be needed in order to assess your foot and to make a customized orthotic device and/or footwear for you. A prescription from your doctor will allow you to claim the cost if you have third party insurance. The ulcer will NOT heal if the pressure cannot be relieved. The device must be worn at all times when you are on your feet.

Various scoring systems and classification of foot ulcers exists. Their intention is to compare the treatment modalities and outcome in different parts of the world. Different parameters are incorporated into these scoring systems such as ulcer depth, its site, presence or absence of infection, neuropathy and arterial insufficiency. All these scoring systems are complex and do not predict long term outcome in the patients. Diabetic Ulcer Severity Score addresses these shortcomings by being easy enough to be applied in day to day clinical practice. Categorising diabetic foot ulcer as ulcer in the foot and ulcer in the toe is in itself a new method.

Amputation 21% 74% Debridement 46% 19% Non-operatively managed 33% 7% In Table 16, there is 74% of amputations were done in cases of diabetic foot ulcer and in 19% of patient’s debridement is done in comparison to Ali S M et al, study shows 21% of amputations and in 46% patients underwent debridement. 11 Authors institute is government tertiary center so patients are form lower socioeconomic class and patients reach to the hospital at the later stage of disease. They took primary treatment at their local dispensaries and some had neglected their disease as the lack of education. 76% of patients have osteomyelitis at the time of admission that required amputations after vigorous combined antibiotic therapy which is used in 98% of the patients. So, percentage of amputations are done are higher in setup than the comparative study (Table 16).

Abstract Background: Diabetes mellitus continues to be a rising concern in the United States. It affects an estimated 9.4% of the population and approximately 1.5 million Americans are diagnosed annually. Approximately 85% of diabetic foot ulcers are associated with diabetic peripheral neuropathy and an infected diabetic foot ulcer is often the first sign of diabetes. There are countless studies within the literature that investigate how insensate feet and the manifestation of a foot ulcer further decrease quality of life and increase risk for mortality. Literature focuses on gait and kinematics that contribute to the formation of a diabetic foot ulcer. While pressure and shear forces are etiologic factors that may lead to the formation of diabetic foot ulcers, the position of the foot while driving an automobile has been ignored as a possible risk factor.

Abstract: Over 415 million people had diabetes in 2015 and the number is projected to increase in the coming years. The complications of diabetes affect millions of people all over the world and diabetic foot is one of the most common. The global prevalence of diabetic foot varies significantly and a reasonable proportion of cases end up in amputation. Despite interventions at various levels, it continues to be a menacing issue in the overall management of diabetes. Diabetic foot ulcer (DFU) is classified as neuropathic, ischemic or neuro-ischemic. Neuropathic ulcers originate in the setting of diabetic neuropathy while ischemic ulcers are secondary to vascular disease. Infections and the intrinsic delayed wound healing that characterizes diabetes are important considerations in the pathophysiology of DFU. The prevention of DFU involves adequate glycemic control and modification of risk factors. While health education is a fundamental obligation of health care professionals, it is paramount that patients adopt the guidelines of feet care and integrate them into daily life in trying to prevent diabetic foot and its consequences. The aim of this review article is to summarize the epidemiology, pathophysiology and prevention of diabetic foot ulcer.

nitroimidazoles disrupt the DNA structure, thereby interfering with transcription and replication. Once metronidazole enters the organism, the drug is reduced by intracellular electron transport proteins. Because of this alteration to the metronidazole molecule, a concentration gradient is created and maintained which promotes the drug’s intracellular transport. Presumably, free radicals are formed which, in turn, react with cellular components resulting in death of the bacteria. Metronidazole is active against most obligate anaerobes, but does not possess any clinically relevant activity against facultative anaerobes or obligate aerobes. In the case of diabetic foot ulcer, blood supply to the wound is less so that more number of anaerobic bacteria’s are present there. the present study has shown metrogyl tablet powder dressing is more successful in wound healing, because metrogyl tablet powder containing more active ingredients than the other formulation like ointments and they act against anaerobic bacteria’s in the wounds. Because of the poor blood supply the topical application of metrogyl tablet powder is more effective for diabetic foot ulcer than the oral and systemic application of other drugs.

To what extent, is it possible to continuously monitor foot ulcer indicators in an efficient, accurate, and user- friendly manner through embedding sensing and communication tech- nologies in daily worn socks? From the literature survey, it is clear that strong indicators are present which can be monitored for predicting ulceration. Proposed sock is designed such that it can be worn throughout the day at home as well as outside. This design aims to achieve more monitoring time than shoe or insole based systems. Since sock design is powered using coin cell, it can work indepen- dently. Use of Bluetooth and android application facilitate data collection and make the overall sock design easy to use. Hence, this design can provide more data samples leading to better prediction of diabetic foot ulcer.

3 Fayez abdulrahman fayez alshahrani, 4 Saeed Faleh Saeed Al Shahrani, 5 Abdullah saad amer alshahrani, 6 Jamaan Rafia Faraj Alshahrani, 7 Abdualla Mohammed A Alshahrani, 8 Yahya Hussain saad Alqahtani Abstract: Diabetes mellitus (DM) is one of the primary problems in health systems and a worldwide public health hazard that has actually increased dramatically over the past two decades. we aimed by this review to demonstrate the approaches of surgical management of diabetic foot ulcers, effectiveness, when to decide for surgical procedures efficiency and outcomes, all through reviewing the evidence based on previous studies. we searched for articles published through October 2016 in the following five electronic databases: PubMed, Science Direct, Embase, Web of Science, and Scopus, for both English and non-English language articles with the following keywords: “diabetic foot ulcer”, “amputations”, “wound management”, “debridement”, “advanced dressings”,

Keywords: Morinda pubescent, methanol extract, natural nonwoven, antibacterial activity, wound healing assay. I. INTRODUCTION Foot wound is a major problem in diabetic patients. They have about 25% chance of developing a foot ulcer in their lifetime and about half of which are clinically infected [1]. The pathophysiology of foot infections in persons with diabetes is complex due to neuropathy, arteriopathy and other factors like microbial virulence, antibiotic-resistance and microbial load of secondary infection causing pathogens of foot ulcers [2]. Patients having foot ulcer with a transcutaneous oxygen pressure value < 30 mmHg use an appropriate shoe with a rigid insole for pressure relief [3]. The currently available insole in market reduces the stress in knee joints and reduces foot problems [4]. But these insoles are expensive and do not possess wound healing property. The synthetic chemicals or drugs used to treat diabetic foot ulcer may raise the cross reactivity inside the body and widely inhibit bio-membrane functions.

Xuemei Li 1,2 , Zhipeng Du 3 , Ziwei Tang 3 , Qin Wen 4,2 , Qingfeng Cheng 3* and Yunhua Cui 5* Abstract Background: Diabetic foot ulcer is one of the major complications for patients with diabetes, and has become an important cause of non-traumatic amputation. Necrotizing fasciitis is a life-threatening soft-tissue infection involv- ing the fascia and subcutaneous tissue. When diabetic foot ulcers are complicated by necrotizing fasciitis (DNF), this increases the risk for amputation and mortality, making DNF treatment more complicated, and eventually leading to amputation and mortality. However, studies on pathogenic bacteria’s distribution and drug sensitivity in DNF patients remain lacking. This study investigated the distribution and susceptibility of pathogenic bacteria in DNF patients, and provided empirical antibacterial guidance for the clinic.

Abstract Pharmacist plays an important role in patients healthcare. Pharmacist is now becoming more patient oriented than product oriented and have brought many changes in life of patients. There are considerable evidence that patients counseling enhances patient compliance and improve the quality of life outcomes in diabetic foot ulcers. Diabetic foot ulcer is one of the major complications of Diabetes mellitus. It occurs in 15% of all patients with diabetes and precedes 84% of all lower leg amputations. Sharp debridement and management of underlying infection and ischemia are also critical in the care of foot ulcers. Prompt and aggressive treatment of diabetic foot ulcers can often prevent exacerbation of the problem and eliminate the potential for amputation. The aim of therapy should be early intervention to allow prompt healing of the lesion and prevent recurrence once it is healed. Multidisciplinary management programs that focus on prevention, education, regular foot examinations, aggressive intervention, and optimal use of therapeutic footwear have demonstrated significant reductions in the incidence of lower- extremity amputations. Community Pharmacist play vital role Patient education regarding foot hygiene, nail care and proper footwear is crucial to reducing the risk of an injury that can lead to ulcer formation. Diabetes currently affects more than 194 million people worldwide and is expected to reach 333 million by 2025,with the maximum burdens falling upon developing countries. India considered as “Diabetic capital of the world”, alone currently counts over 35 million peopleharbouring diabetes. This is estimated to touch 73.5million by 2025 as a consequence of longer life expectancy, sedentary lifestyle and changing dietary patterns.

Although Case 4 and Case 7 did not receive adequate IV antibiotics to treat the A. faecalis infection, they received surgical intervention and wound care. Their diabetic foot ulcer infection were healing. Their diabetic foot ulcer were local infection that could cure by adequate debridement and appropriate wound care.This result stresses that wound care and surgical interventions are important in treating diabetic foot ulcer infections. In three cases, the diabetic foot ulcer did not heal. Case 5 had wound infection complicated by septic shock. This patient had to undergo right lower leg below the knee amputation to save her life. Case 6 had the comorbidities of peripheral artery disease (PAD) and chronic kidney disease (CKD). The duration of his diabetic ulcer lesion was 12 months. The patient received IV antibiotics with ceftazidime and tigecycline therapy, as well as debridement, but the leg ulcer lesion still failed to heal.

However, diabetic foot ulcer (DFU) assessment require frequent clinical visits to diagnose the ulcer healing status by health professionals which is very costly and time consuming for patients. The clinical assessment of DFUs represents a critical task to perform an accurate diagnosis and to select a suitable treatment [3]. The wound assessment process is based on visual examination, clinicians describe the ulcer by its physical dimensions (area and volume) and the nature of the different skin tissue types inside the wound bed such as granulation, slough, and necrotic ones [4]. Assessing color and proportion of these tissues help to determine the healing

Introduction: Some studies have reported that diabetic patients do not adhere well to the foot care recommendations. Reasons for non-adherence are less evident and the methods used in education programs may have an effect. Therefore, the aim of the present study was to compare the effects of lecture method and combined method of education on foot care of patients and healing rates of diabetic foot ulcers. Methods: A matched controlled trial study was conducted on a sample of 45 diabetic patients with foot ulcers. The two intervention groups were taught with similar content but different methods. Patients’ foot care and healing rates of diabetic foot ulcers were assessed at the beginning of study and after 3 months in the two training groups as well as the control group. Results: Ulcer surface was decreased by 46%, 61% and 81.6% in the control, lecture group and com- bined group, respectively. The ulcer depth was also decreased by 66.7%, 97.5% and 69.1% in the three groups respectively. A significant relationship was observed between the group adherence of the self-care program and the amount of decrease in the ulcer surface area (r = 0.36, p = 0.04). Conclusion: The foot care education could significantly affect the healing of diabetic foot ulcer, especially in terms of the ulcers’ surface area. Therefore, a self-care education program should be integrated in the health system to empower those living with diabetes to manage their own foot appropriately.

Being a serious health concern for diabetic patients, successful clinical management that involves early detection and effective preventive care of the DFUs will significantly reduce comorbidities and thus in the long run improve the quality of life for the patients. To achieve maximum accuracy thorough and critical evaluation of the ulcer should be done for proper management. This evaluation should include an efficient and sufficient description of ulcer characteristics, such as size, ulcer depth, appearance in texture as well as the location on the foot to ensure proper assessment of the progress during treatment (Mavrogenis et al., 2018). To enhance the accuracy in evaluation with the aim of improving diabetic foot ulcer healing and prevention of lower limb amputation, imaging and non-invasive tests are essential.

Background: Foot ulceration is preventable, and relatively simple interventions can reduce amputations by up to 80%. The objective of the present research was to study the prevalence and risk factors of diabetic foot ulcer among diabetic patients Methods: Present study was hospital based cross sectional study carried out at outpatient department of General Medicine for a period of January 2018 to June 2018 among 200 diabetic patients. All eligible patients willing to participate were included in the present study. Diabetic foot ulcer was diagnosed as per the standard criteria and based on the physician acumen. An attempt was made to identify the risk factors like smoking etc. The diagnosed patient was given appropriate treatment.

22. Schaper NC. Diabetic foot ulcer classification system for research purposes: a progress report on criteria for including patients in research studies. Diabetes Metab Res Rev. 2004;20 Suppl 1:S90 – 5. 23. Smith SC, Cano S, Lamping DL, Staniszewska S, Browne J, Lewsey J, van der Meulen J, Cairns J, Black N. Patient-reported outcome measures (PROMs) for routine use in treatment centres: recommendations based on a review of the scientific evidence. In: Final report to the department of health December. London, UK: Health Services Research Unit, London School of Hygiene & Tropical Medicine; 2005. Available: https://www.lshtm.ac.uk/php/

Better control of blood sugar levels, early recognition of complications of peripheral neuropathy and ischemia, and using a multidisciplinary approach to therapy when an ulcer develops can dramatically reduce this problem. Primary anti-diabetic therapy includes oral anti-diabetic insulin or combination of both. Supportive therapy includes antibiotics for diabetic foot ulcer and physical measures like routine wound dressing and washing. In antibiotic therapy, much more care should be advised because, over usage of antibiotics produces multiple drug resistance. This produces development of antibiotic resistant strains in the locality.

Our group recently completed a large, multicentre, cross- sectional study that compared culture results from swab and tissue specimens concurrently obtained from people with a diabetic foot ulcer with suspected infection (the Concordance in Diabetic Foot Ulcer Infection [CODIFI] study) [21]. This study collected comprehensive clinical details, including ulcer classification using both the PEDIS (perfusion, extent, depth, infection, sensation) [22] and the Wagner systems, and wound culture results. After gaining additional funding we obtained consent from participants to enrol them in a prospective observational study to assess the 12-month clinical outcomes of people with a clinically infected diabetic foot ulcer and to explore prognostic factors related to the incidence of wound healing.