Written by: Lauren Schuermann
Medically reviewed by: Dr. Ralph J. Napolitano Jr., DPM, CWSP, FACFAS
Wham! — the English pop duo with famous songs such as “Wake me up before you go, go?”
No, WHAM! is the acronym for Wound Healing Awareness Month developed by the American Board of Wound management! This annual wound care awareness celebration happens annually in June and is dedicated to patients affected by chronic wounds.
The wound management foundation organizes this event to emphasize the critical work done by physicians who have been trained in wound healing and the importance of research to understand the complexities of wound healing science.
As this year’s WHAM! recently came to a close, I felt it necessary to raise further awareness for a seemingly common yet complex diabetic consequence—that being diabetic foot ulcerations.
Ralph Napolitano Jr., DPM, CWSP, FACFAS, the Director of Wound Care and Healing at OrthoNeuro in Columbus, Ohio, detailed his knowledge of diabetic foot ulcers in his article “A Step Ahead: If You’re Diabetic That Wound On Your Foot May kill You. Really.” He spoke about the complications associated with diabetic foot injuries and the importance of regular foot care.
This blog will discuss the disease mechanism, possible complications, treatment, and promising research involving diabetic foot ulcers. It will also discuss the importance of bringing awareness to diabetic foot ulcerations.
If you have further questions regarding wound care awareness month and/or diabetic foot ulcers, schedule a consultation with our certified wound specialists at OrthoNeuro. Our certified wound care specialists will educate you about the causes and treatment of diabetic foot ulcers and other surgical wounds. Call us or book an appointment online today!
The mechanism of ulcerations because of diabetes is heavily studied. Many professionals have agreed that ulcerations result from poor glycemic control, peripheral vascular disease, improper foot care, and underlying neuropathy.
Poor glycemic control is due to uncontrolled diabetes. Diabetes mellitus results from insulin insufficiency due to the overuse of insulin-producing beta cells in the pancreas, leading to their dysfunction. Due to the dysfunction, less insulin is released.
Therefore with a poor diet, patients experience an excess in sugar. Excess glucose levels have been heavily related to poor wound healing results. Most studies suggest that a diabetic hemoglobin A1C over eight is not ideal for wound healing and can impede wound healing.
Peripheral vascular disease is associated with diabetes by affecting the lining of cells in the blood vessels — blood vessels are not as flexible as they should be for blood to flow smoothly. Therefore, with decreased blood flow through the vessels and an inability for essential proteins to be transported through the cells, there is less wound healing ability.
Blood flow is essential to wound healing. Blood flow allows cells, such as those crucial to preventing infection—white blood cells—and molecules such as platelets to begin closing the wound. Peripheral vascular disease can also be associated with the underlying neuropathy associated with diabetes.
Neuropathy occurs due to the lack of blood flow to the small vessels that supply the nerves. Therefore, the nutrients supplying these nerves are cut off, and the cells begin to die.
When these die, people develop neuropathy. There are four general types of neuropathy associated with diabetes, but the most common is distal symmetrical peripheral neuropathy.
This type of neuropathy is associated with numbness or reduced ability to feel pain or temperature in the lower extremities. When trauma occurs to the lower extremities, patients do not recognize the trauma and have an increased risk of infection as patients do not take care of the injury.
Lastly, improper foot care is an attributor to diabetic foot ulcerations. Patients may not regularly clean their feet or may have problems accessing their feet due to age or other comorbidities. This neglect may lead to a lack of cleanliness or injuries that are not taken care of promptly—leading to foot ulcerations.
Complications of diabetic foot ulcers can be severe, the most severe being infection resulting in sepsis (systemic infection) or amputation. The severity of the infection typically determines the path the physician will take in treating the patient. Infection in the bone, in which osteomyelitis, crepitus, and possible sepsis are the results, typically indicates amputation.
Amputation is never the desired result, as the mortality rate of those who undergo amputation is about five years following their amputation. Other complications may include a chronic wound healing condition, resulting in increased office visits, lifestyle changes, and financial burdens on the patients.
Currently, treatment for diabetic foot ulcers follows guidelines to obtain healing as soon as possible. The purpose of healing the wound quickly is to prevent the complications that were mentioned above.
Current treatment includes infection prevention, off-loading (taking pressure off the area), debridement, and managing blood glucose and other health comorbidities.
Infection prevention involves keeping the ulcer clean and bandaged. Many physicians recommend cleansing the wound daily while using a wound dressing or bandage for coverage.
Some of the topical ointments may be antimicrobials, such as gentamycin, triple antibiotic ointment, or silver, or may be highly absorbent for exuding wounds, such as foam and alginate.
Off-loading is essential for wound healing. Off-loading is taking pressure off the wound. It promotes healing, so the wound does not break open, risking further complications. An orthotic shoe insert is sometimes prescribed to take pressure off the wound while allowing the patient to remain mobile.
Debridement is a technique used to stimulate the tissue and also clean out the wound. Excess tissue deposition in the wound may inhibit the healing process.
The physician may remove this while stimulating the live tissues around the wound to promote healing. The debridement may also be to clean up the wound if an infection is present.
Finally, management of blood glucose is essential. High blood glucose causes a systemic inflammatory state, which does not allow for focused localized inflammation at the wound site to promote healing. This leads to wound chronicity and a lack of recovery.
Currently, there is research focused on healing diabetic foot ulcers. The research includes the most beneficial dressings, technology such as negative pressure wound therapy or hyperbaric oxygen treatments, and even skin substitutes. As new treatments come to focus, the laborious task of healing these ulcers may reduce.
One must understand that diabetes can have severe consequences if not appropriately managed. One of these consequences is diabetic foot ulcers and the complications that may arise with those. That is why the topic of diabetic foot ulcers was so crucial to this month’s Wound Healing Awareness Month.
Dr. Napolitano’s role as a wound care specialist diligently expresses the need for controlled diabetes. A large part of Dr. Napolitano’s practice at OrthoNeuro is lower limb wound care. He utilizes state-of-the-art, cost-effective techniques to heal wounds as quickly as possible.
He also provides critical foot care to prevent diabetic foot ulcers from occurring. WHAM! recognizes and applauds physicians like Dr. Napolitano, who care for chronic wounds. WHAM! is also dedicated to researchers focused on wound healing investigation. Although wound healing awareness month may pass, the fight will continue to manage and cure patients with debilitating foot ulcers.
If you have questions about diabetic foot ulcerations, other surgical wounds, or wound care awareness month, schedule an appointment to speak with one of our certified wound specialist physicians at OrthoNeuro.
Our certified wound care associates specialize in wound prevention and other wound care services and have successfully treated many wound care patients. Call us to book an appointment today!
