Peachstate Advanced Cardiac & Endovascular
Board Certified Interventional Cardiologists & Vascular Specialists located in Newnan, GA & Hampton, GA
Up to one-third of people with diabetes develop a foot ulcer during their lifetime. The team of skilled doctors at Peachstate Advanced Cardiac & Endovascular can help with a broad range of advanced treatments that protect your foot and whole-person health. Diabetic wound care techniques like hyperbaric medicine and patient-specific antibiotics combine with blood sugar control and other techniques to help you heal and return to full form. There are offices throughout the state of Georgia, so call the one nearest you or book an appointment online now.
What is diabetic wound care?
Diabetic wound care is medical care for ulcers (wounds that won’t heal). People with diabetes don’t heal as quickly as others due to consistently high blood sugar.
Wounds might start as small nicks or cuts, but pressure from walking, standing, or even wearing shoes worsens the injury, eventually causing an ulcer.
Diabetic ulcers usually form under your big toe and on the balls of your feet. When left untreated, diabetic wounds can become very deep, eventually exposing the bones in your feet. They’re also prone to infection, which leads to necrosis, and in severe cases, amputation.
Diabetic wound care identifies and addresses all of these concerns and helps your body heal with maximum efficiency. When you start diabetic wound care early enough, you can save your foot, leg, and mobility.
When might I need diabetic wound care?
If you have diabetes, you should think about diabetic wounds before they even happen. Doctors encourage people with diabetes to schedule simple toenail maintenance and foot checks regularly. This helps you avoid injuries and get early treatment if you injure yourself.
However, if you already have a diabetic foot wound, call Peachstate Advanced Cardiac & Endovascular right away. Don’t assume that you can take care of your wound on your own. Diabetic wounds don’t heal like regular injuries and need specialist care.
How does diabetic wound care work?
Peachstate Advanced Cardiac & Endovascular provides comprehensive diabetic wound care. This includes three general stages.
Identification involves a complete foot and limb exam.
Exams look for current foot ulcers and also screen for at-risk areas like pressure points atop bony areas of the foot.
Treatment depends on your specific foot wound. If you have an infection, wound testing identifies the organisms involved and helps the team determine the ideal antibiotics to target it.
The team also performs debridement (removal of dead tissue), provides wound dressings, and administers other therapies like hyperbaric medicine to stimulate faster healing. Controlling your blood sugar is a crucial aspect of healing as well.
Preventive tactics include continued blood sugar management, a healthy diet, wearing proper shoes (possibly prescription footwear), compression stockings, and managing comorbid conditions like hypertension with medication or other means.
Don’t delay treatment if you have a diabetic wound. Call Peachstate Advanced Cardiac & Endovascular or make an appointment online — it could save your foot or your life.
The integrity of all tissue is negatively impacted by hyperglycemia, and nerve tissue is no exception. Nociceptors are pain receptors that fire off (depolarize) along the nerves that ultimately reach the brain where all pain is perceived. When the nerves are damaged by hyperglycemia, a condition called hypoalgesia begins. This essentially raises the nociceptive threshold beyond which pain sensation is generated.
Numbness and decreased pain response to trauma put the lower extremities and feet at significant risk for unnoticed (unattended and untreated) injury in diabetics.
Peripheral Vascular Disease (PVD)
Low oxygen (hypoxia) is the end result of diseased blood supply to tissues. PVD thereby affects both the nerves in their function and the tissue negatively impacted by repeated trauma: healing is significantly impaired. Both the arteries and veins in diabetics are affected, and infection from venous involvement is prone to rapid progression.
There is a directly proportional relationship between chronic glucose elevation and neuropathy and peripheral vascular disease, making strict glycemic control the mainstay of prevention and treatment.
Other comorbidities will impact the neuropathy, peripheral vascular disease, and hyperglycemia that results in the diabetic risk of trauma and infections:
- Dyslipidemia (abnormal cholesterol and triglyceride levels).
- Drug abuse
Types of Diabetic Wounds
The most common diabetic wounds are pressure ulcers and those from lower extremity trauma. Untreated diabetic wounds result in the extension of infection and tissue damage, the end-point of which includes sepsis, the need for amputation, and death.
Can Diabetic Wound Care Be Diagnosed?
Diagnosis of pressure ulcers (“decubitus,” “decubiti,” pl.) and infections and injuries of the feet, lower extremities, and other areas are by inspection. Infection usually is accompanied by odor and a discharge (exudate of purulent secretions). Pressure ulcers in the feet can indicate improper shoe fitting.
Both infected areas and uninfected areas may look the same. The definitive diagnosis of infection is via a culture retrieval from the site and then testing the infectious microorganism against several antibiotics to judge their efficacy of them. This drives the decision of antibiotic choice.
A test for sensation to pain, pinprick, and light touch is necessary to identify problem areas for prophylactic padding.
Peripheral vascular disease may compromise the arterial blood supply to tissues, and an arteriogram can demonstrate areas of poor perfusion. Nerve conduction studies can point out nerve tracts that are not functioning properly.
Diabetes injury occurs because of hyperglycemia, and evaluation of the patient’s glycemic control is done with serial glycated hemoglobin A1c.
Other tests with diabetic injuries should assess the total well-being of the person at risk of cardiovascular, eye, and kidney disease from his or her diabetes. These can be done using ECG, kidney function tests, and a thorough ophthalmological exam.
Management of diabetic wounds is on identification, treatment, and prevention.
A careful physical appraisal of the diabetic patient in an exam may not be enough to indicate areas of concern. A history from the patient indicates subclinical preludes to overt diseases, such as tingling and numbness.
Pressure points, especially over bony prominences, require additional scrutiny because of possibly more serious bone infections underlying the skin.
After identifying infected areas, culturing them, and identifying the responsible organism(s), the sensitivity test will indicate the best choice(s) of antibiotic(s). With ongoing wound care, scrupulous follow-up with the treating physician will assure that the protocol being used and choice of antibiotics are effective. Treatment failure may indicate bacterial resistance or patient immunocompromise.
The linchpin of management and treatment is strict glycemic control, counseling with a dietitian/nutritionist, exercise, and avoidance of alcohol to offer the best chance for glucose management success.
Prevention of Diabetic Wounds
Prevention of diabetic injuries and the wounds they cause is first by strict glycemic control, that is, keeping the target hemoglobin A1c level < 7.0
Injuries that progress toward amputation require prosthetics. Prevention of new injuries from prosthetics is crucial. This is accomplished via fitting by professional prostheticians. Thereafter, routine follow-up re-checks of the equipment are necessary to appraise it for wear-and-tear and changes in the patients that result in ill-fitting.
Arterial compromise as part of peripheral vascular disease can be monitored via imaging studies, including contrast media and ultrasound. Venous compromise may necessitate compression stockings which require great caution to prevent superficial necrosis of the skin.
Aggressive debridement of pressure ulcers and other sites of infection is for stopping their progress, which can pose a risk of sepsis.
Management of hypertension with antihypertensive medication is indicated and a routine of periodic evaluations to determine cardiac health will not only improve mortality but offer extra opportunities for surveillance of healing injuries.
Smoking cessation, a reasonable ADA diet with reasonable expectations, and a team approach that includes the primary care physician, endocrinologist, wound team, dietitian/nutritionist, and when necessary, physiatry and physical therapy.
The best global approach to prevention is by frequent inspection of the feet and legs by podiatry and primary care to identify any areas with warning signals.
We are just a call or click away. To learn more, book an appointment online or over the phone with PeachState Advanced Cardiac & Endovascular. We have several locations in Georgia: Newnan, Atlanta, Hampton & Villa Rica.
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