New Treatments for Foot Wounds In Diabetics Can Save Limbs - And Lives
By Alexander M. Reyzelman, DPM
A blistered toe or a scraped heel may be minor annoyances to most people, but to long-term diabetics, these injuries can allow deadly bacteria to enter the body, leading to foot sores and ulcers. Because these patients often have poor circulation in the lower limbs, they have a harder time fighting off this bacterial invasion, and if the infection spreads, it can lead to gangrene, amputations, or even death.
New approaches to treating foot wounds, however, are changing this dismal picture for more than 240 million people worldwide who have diabetes and for those who face the possibility of losing a lower extremity because of the disease, estimated at 60,000 people each year in the U.S. alone.
These new treatments range from bio-engineered skin repair and growth factor therapy to new shock wave therapy (currently under clinical trials), and they offer hopeful options to diabetics who are often unaware that they may have alternatives to amputation.
To implement these new options, patients are turning to podiatrists – physicians who specialize in treating the foot. Diabetics who develop peripheral neuropathy, in particular, need podiatric care because this condition causes a loss of sensation in the feet and blunts pain signals, so the patient may not be aware of small cuts or blisters until they are seriously bleeding and infected.
Traditionally, podiatrists treat diabetic foot ulcers by first cleaning and removing non-viable (dead) tissue from the infected area through a process called “debridement.” They also apply bacteria-fighting dressings to the area, prescribe appropriate antibiotics, and recommend special shoes or bracing to take pressure off the foot wound.
These standard remedies are designed to give the body an opportunity to heal itself – but the new bio-engineered skin repair products (such as Apligraf® and Dermagraft®) take that idea one step further. Since the diabetic’s body may not be able to circulate sufficient blood flow to repair wounds, these patients need an extra boost to stimulate healing. That boost is provided by living, fast-growing human cells that deliver ingredients such as growth factors, nutrients and proteins directly into the wound. These bio-engineered cells (usually taken from the neo-natal foreskin of circumcised infants) can be embedded in a high-tech bio-absorbable mesh which is placed in the wound to activate growth of the patient’s own skin; and that, in turn, allows foot ulcers to close up.
Shock wave therapy (including Sanuwave’s dermaPACE™ device) also works on the principle of marshaling the body’s healing forces. This non-invasive therapy (already in use against kidney stones) aims high-energy pulsed acoustic waves to the wound area. The cellular stress produced by these waves increases circulation in that area and signals the release of specific proteins and growth factors that generate new blood vessels, all of which enhances the body’s self-repair capabilities.
While these new treatments represent important breakthroughs in treating diabetic foot wounds, the best approach is to prevent them from developing in the first place. For diabetics, that means inspecting their feet daily for blisters and cuts, wearing foot protection at all times, quitting smoking, and scheduling regular foot checkups with their doctors or podiatrists.
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Dr. Reyzelman is a board-certified podiatrist with an office and hospital privileges at Eden Medical Center, both in Castro Valley. To reach Dr. Reyzelman call (510) 581-1484.