Dr. László Mecseky
Diabetic Leg Specialist
President of Diabetic Leg Alliance, Hungary
Founder of National Diabetic Leg Screening Program at Hungary
Foot related complications leading to the appearance of wounds and ulcers often arise with diabetic patients. The most common reasons of this is the negligence of the most basic preventive measures.
The feet of diabetic patients require enhanced care and attention as well as proper treatment on an everyday basis. It is essential to treat the skin and the nail lesions, relieve the chronic pressure points on the sole of any burden as soon as possible and protect the vulnerable foot area with the use of tailor-made shoes and insoles.
The high-risk diabetic patient, if walking in slippers or open sandals, might actually suffer multiple injuries of various degrees which might remain unnoticed since in most of the cases the patient is highly insensitive to stimuli due to the untreated diabetic neuropathy.
Diabetes related nerve damages cause increased keratosis, perspiration disorders and the drastic decrease of the hyaluronate content of the skin, as a result of which the skin becomes increasingly vulnerable.
In most cases ulcers appear on surfaces exposed to friction or on pressure points located on the sole. Complications can be prevented if the patient wears suitable hard sole shoes and protects their skin with increased treatment thus ensuring its proper resistance.
The early daily application of the gel containing zinc-hyaluronate and the removal of corns and callosities not only prevents skin damages and vesication but facilitates the healing process at the already existing wounds as well.
If the problem is serious already and the infection caused by superficial injuries has already extended into the deep tissues, the foot can be saved only with wide surgical exposures. The surgical wounds of a diabetic foot must not be sewn up, it has to be treated openly with professional wound cleansing, modern dressing materials and antiseptics. In order to ensure the proper and seamless healing of big wounds and the earliest possible recovery of their flexibility and resistance, daily application of the gel containing zinc-hyaluronate is highly recommended. The preparation, due to its hyaluronate content, facilitates wound healing, whereas its zinc content helps prevent superinfections. Therefore the scar becomes flexible and more resistant. Based on our experience acquired through the treatment of several thousand patients the chance of new ulcers appearing diminishes enormously.
The prevention of the recurrence of plantar wounds is of crucial importance because of the extremities as indicated by the disappointing world statistics figures. 80% of the plantar ulcers reappear within 2-3 years.
All new shoes, even if they are tailor made orthopaedic ones, might entail injuries after the first use and therefore can be used only with great care. In this case it is especially important that the skin should be preconditioned in order to prevent the transformation of banal superficial skin injuries into severe inflammations extending into the deep tissues. If the healing process requires temporary cast or orthosis, i.e. a high boot supporting the kneecap tendon and relieving it of any pressure, minor injuries on the skin inevitably appear. Even such basic elements of wound treatment as flexible bandaging or the use of compression bandaging can cause skin lesions in the learning period, i.e. up to the time when the patient or their relative learns the proper technique. With the regular use of the gel containing zinc-hyaluronate there is a high chance of prevention of such grave consequences.
When delivering the protecting shoes it is highly advisable to provide comprehensive information as well as medical surveillance to the patient since the proper acquisition of the special gait is very important. It is good news that the increasingly proliferating Diabetes Foot Outpatient Care Centres are suitable for providing complex treatment. In these centres there is an increasing number of medical and chiropody treatment available, which allows for the removal of dangerous nail lesions and callosities with medical surveillance in professional circumstances.
Providing detailed explanation to patients on skin care and the various degrees of skin damages is a fundamental part of the treatment as well. The reason why it is important to emphasize this is that most amputations can be accounted for by seemingly banal lesions on the toes.
In the Diabetes Foot Outpatient Care Centres there is an extending opportunity to save the highest possible number of limbs of diabetic patients from amputations as a result of the joint cooperation of diabetologists, infectologists, surgeons, vascular surgeons, trauma surgeons, orthopaedic surgeons, orthopaedic shoemakers, chiropodists and physiotherapists as well as the active involvement of the patient. With the proper treatment of the feet the appearance of wounds can be prevented and with proper medical treatment by a competent professional the already existing wounds can be cured, moreover, their recurrence is preventable as well.