Non-Surgical Diabetic Foot Treatment
What Is Non-Surgical Foot Treatment?
All diabetic foot conditions need some of the following non-surgical treatments. Some patients may need only non-surgical treatment and in some cases operation can be avoided if patients go to the specialist in early stage. Having a specialist who understands use and limitations of all these treatments can help save many diabetic feet.
Following Topics Are Covered Briefly Here
Medical treatment – Antibiotics, insulin, IV fluids.
Specialized dressings – For complex wounds.
Plaster – customized and specialized Plastering /Offloading.
Suction therapy – NPWT/VAC (Negative pressure wound therapy/ Vacuum assisted closure).
HBOT (Hyper Baric Oxygen therapy).
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Medical treatment
a) Antibiotics – Infections like cellulitis, abscess, gangrene, and fasciitis will need antibiotics.
o Initial choice of antibiotics is decided empirically (by a logical guess, using the antibiotics that work against the usual suspects in that area based on previous experience). Later on, culture report helps to decide specific antibiotics.
o Typically, broad spectrum antibiotics that kill many types of bacteria are used.
o Antibiotics are given intravenously (through a cannula needle in vein) in serious infections, ideally in the setting of a hospital.
o In severe infections many a time, more than 1 antibiotic is used.
o Antibiotics need to be constantly checked and changed as per the culture report. The bacteria in the wound change totally or they just become smart ‘resistant’ (certain antibiotics that were working, become ineffective)
o Dose – One needs to be careful with dose. All antibiotics have side effects. Because most of these patients have heart or kidney problem. Antibiotic dose should be enough to kill bacteria but not to cause side effects. So, it can be a very tricky business. Sometimes you have to accept the risk of side effects.
o Not all wounds need antibiotics.
o Antibiotic are also used for dressing the wound. They will be discussed in dressing
b) Insulin and IV fluids are given initially to make the patient stable quickly, hydrate him and bring sugars to normal.
c) Necessary treatment of medical conditions like heart, kidney, etc.
Specialized dressings
Purpose of dressing is mainly to keep the wound moist and clean and protect further damage. One can also keep an eye and detect worsening or need of proper operative cleaning.
o Basic dressing – Saline, gauze piece and bandage.
o Special dressing – Vaseline gauze, special gels
o Medicated dressings with antibiotics.
o Dressings with growth factors to enhance healing
o Dressings with growth factors to enhance healing
Plaster
It is part of ‘Offloading in diabetic foot’. Plaster gives rest to the diseased part. Purpose of plaster is to give support to dressing in such a way that the diseased area doesn’t get pressure, gets rest, improves circulation and starts healing. This is one of the most important part of all diabetic foot dressings. Many wounds don’t heal because this part of treatment is ignored.
o Usually plaster of fiberglass material is preferred now a day rather than plaster of paris. Fiberglass plaster is sturdier and can sustain whole weight of the person.
o Usually plaster of fiberglass material is preferred now a day rather than plaster of paris. Fiberglass plaster is sturdier and can sustain whole weight of the person.
o Customized. Each plaster needs to be customized. For example, ulcer on front of the foot will need different shape of plaster than an ulcer on the heel.
o Padding – Good padding inside and outside of plaster is very important, lest the plaster itself will cut the skin.
o A walker or walking stick is a good ancillary.
Suction therapy – NPWT/VAC (Negative pressure wound therapy/ Vacuum assisted closure).
o A low suction is constantly applied to keep the wound clean. This avoids the need of regular dressing; instead a change can be done every 5 days. This is of a great help, socially and medically.
o Evidence shows that it improves the rate of healing and helps avoid amputations.
o It can be done even at home in selected cases.
o This is discussed in more detail in ‘Special treatment and advances in diabetic foot’
HBOT (Hyper Baric Oxygen therapy)
o Patient gets 100 % oxygen under high pressure. This is supposed to improve healing in very select cases of diabetic foot with circulation problems.
o It is extremely difficult in diabetic foot patient from logistics point of view.
o Discussed in more details in ‘Special treatment and advances in diabetic foot’
Specialized Footwear for diabetic foot
It is part of ‘Offloading in diabetic foot’. Good footwear helps in preventing any injuries and ulcers, and help in healing of diabetic foot wounds. It is discussed in more details in ‘Footwear in Diabetic foot’
Whatever the footwear, it should have these 3 basic qualities.
o Thick soft insole to distribute pressure
o Broad in front to avoid crowding of toes
o Covering the whole foot from all sides<
Practically, In India, for most patients a simple sports shoe of 1 size bigger than your foot size and socks will usually be enough. These may do better job than the so called diabetic shoes available commercially. In certain special condition, one may need specialized shoes. Your diabetic foot doctor should be able to help you.
• Specialized shoes include – wedged shoes, customized shoes, insoles made by CAD/CAM technology, air cast shoes, etc.
• Discussed in more details in ‘Specialized Footwear in diabetic foot’
Walking aids
It is part of ‘Offloading in diabetic foot’. Walking aids enable the patient to move from one room to other and to toilet. The preservation of autonomy and privacy makes a great difference to the mental and physical health of the patient Walking aids are very useful in avoiding pressure on diseased part and keeping the patient mobile
Typically a four-legged walker without wheels does the job. Your diabetic foot doctor or physiotherapist can help you learn to walk on walker.