More than 25-million Americans have diabetes, placing them at greater risk for developing limb threatening ulcers or wounds. The problem is often worsened by nerve damage (diabetic neuropathy), which occurs in half of all people with diabetes and diminishes their ability to feel pain. As a result, many diabetics sustain foot wounds or injuries without knowing it and wait too long to treat their condition.
“If you’re a diabetic, you should be checking your feet regularly to identify potentially serious problems,” and also have regular evaluations by a specialist, says podiatrist Robert K. Lee, D.P.M., a member of the multidisciplinary team of experts at the UCLA Center for Wound Healing and Limb Preservation.
As part of a diabetic foot evaluation, doctors educate patients about appropriate foot hygiene and footwear and check their feet for dry, rough or cracked skin, blisters and sores, thick, yellowed or ingrown toenails, infections, gangrene and deformities. Patients also learn about managing their diabetes.
“In the last 10 to 20 years, we’ve seen an explosion of technology that enables us to better tailor wound care to the needs of each patient,” Dr. Lee says. At UCLA, for example, patients have access to approaches such as negative-pressure therapy and total-contact casting, which are not readily available outside of specialized wound-treatment centers.
Unfortunately, “sometimes patients seek help so late in the process they already risk losing a foot or a toe,” says vascular specialist Peter Lawrence, M.D., director of the Gonda (Goldschmied) Vascular Center. Any wound that fails to heal within 30 days should be evaluated by a multidisciplinary team of wound-care specialists, Dr. Lawrence says. Whether a non-healing wound is the result of an accidental injury or the sign of a circulatory or vascular problem, it requires specialized care, he says.
In addition to therapies such as angioplasty or bypass surgery to treat non-healing wounds, skin substitutes and growth-factor products manufactured in the lab offer new approaches to address the problem. Stem-cell therapy offers another promising wound-healing treatment that currently is in clinical trials at UCLA. Hyperbaric therapy, which infuses high-pressure oxygen into tissue to kill infectious bacteria and stimulate wound healing, is also an option for some patients. An arterial-assist device – a blood pressure type cuff that applies compression to the foot, ankle and calf to circulate blood flow – represents another noninvasive option that can be used at home.
“We see dramatic improvement in diabetic wound patients treated using the right approach,” says Steven Farley, M.D., medical director of the UCLA Center for Wound Healing and Limb Preservation. The multidisciplinary center addresses all the components of wound healing: ischemia, diabetes management, nutrition, biomechanical, infection management complicated wound coverage and advanced wound-care modalities.
“The bottom line is that diabetic patients with wounds that linger for more than a month should seek care,” Dr. Farley says.