Foot ulcers in diabetic patients
are a result of consequential risk factors interaction. It is important to know
that these ulcers don’t occur spontaneously and there are preventive methods
which can directly influence the development of foot ulcers. While these foot
ulcers are resulting risk factors of diabetes, this is essential to understand
how and why these ulcers; which can be helpful in developing initiatives
regarding ulceration prevention.
The common risk factors for ulcer
formation are diabetic neuropathy, structural deformity, and peripheral
arterial occlusive disease. A careful physical assessment is required which can
identify patients at risk for foot ulcers and appropriately differentiate
patients who already have ulcers or other Diabetic Foot complications.
Nerve damage (neuropathy) is the
most common in diabetes, affecting more than 20%- 50% of people with the
condition. Neuropathy may result into painful symptoms in a person’s legs,
which either become typically worse at night, or may be completely painless –
the person’s feet may not feel anything mostly due to numbness. A dangerous
situation would be if the pain and temperature sensation; normally crucial for
general protection from injury are lost due to lack of blood circulation. Thus,
this may affect patient’s feet without their awareness. Although neuropathy is
not only responsible for ulceration but it permits injuries to develop without
being noticed.
Other
risk factors contributing to the development of diabetic foot ulcers may
include smoking, malnutrition, immobility, older age, deficiency in cognitive
function, lack of insight, and inability to follow optimal management (such as
lower extremity elevation) because of other significant co morbidities. Smoking
is known to have negative effects on wound healing outcomes and essentially
doubles the complication rate for any surgery or wound healing intervention as
compared to nonsmokers. Metabolic syndrome is another risk
factor for development of foot ulcers. It includes a combination of
hypertension, abdominal obesity, hyperglycemia, dyslipidemia
(hypertriglyceridemia and low high-density lipoprotein), and is a precursor of diabetes.
Consequently, it is crucial to initiate appropriate management before a problem
arises. Improper management can lead to serious and costly wound care problems.
The first step in any preventive
care is patient education. There are treatments available for DFU which can
help in managing the severity of foot ulcers. Moreover, despite the advances in treatment options, the outcomes for the patients
with DFU’s have not improved. The successful treatment is hindered by the lack
of targeted therapy that hones in on the healing processes deregulated by
diabetes. In that regard, PRP can be a promising tool, being capable of
bypassing the underlying abnormal healing mechanism as well as accelerating the
initial healing stages such as inflammation, secretion of immune cells and
proliferation of damaged cells.
With
the advancing technology, the treatment implementing Platelet Rich Plasma, is
gaining popularity as a biological booster to accelerate body's delayed healing
mechanism and maximize cell proliferation. The use of PRP is a very efficient
technique being employed since 1990's to promote healing of the soft tissues as
well as wounds and is categorically attracting many doctors, due to it's
incredible outcomes; that have been observed through various clinical trials
The PRP is a platelet concentrate with liquid plasma portion containing various
essential growth factors, important to promote cell recruitment, multiplication
as well as specialization, for faster healing.
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