With the increasing incidence of diabetes the need for experienced diabetic wound care specialists in Arlington Heights and the Chicagoland area is greater than ever. Dr Natalie Domek with Podiatry of Arlington Heights has spent her career specializing in diabetic wound care of the foot and lower extremity. Dr Domek was extensively trained in wound care and limb salvage at Hines Veterans Affairs Hospital during her residency training and has taken her knowledge and passion for diabetic wound care to the private practice setting in Arlington Heights.
The Stats:
- According to the American Diabetes Association the incidence of diabetes in the United States is approaching 10%
- According to the World Health Organization nearly half a billion people world wide have diabetes
- More then one third of individuals with diabetes (34%) with develop a diabetic foot ulceration
- After healing a diabetic foot ulceration the reoccurrence rate is 40% in the first year alone.
- Mortality rates as high as 50% have been reported within 5 years of developing a diabetic foot ulceration.
Prevention:
- Annual, biannual or quarterly foot examinations by a podiatrist based on your risk level of ulceration.
- Daily foot checks at home.
- Diabetic shoe gear.
- Avoiding barefoot walking
Treatment:
- Wound debridement
- These can be done in the office or in an OR setting depending on the severity of the ulceration.
- Serial debridements of diabetic wound help to remove any devitalized tissue or excessive callus build up as well as any biofilm that the wound produces that can decelerate wound healing
- Antibiotic therapy
- It is not uncommon that diabetic wounds can become infected. Infections can range from soft tissue infections (cellulitis) to deeper abscesses or even bone infection (osteomyelitis).
- Depending on the severity of infection antibiotic therapy can range from 7 days to 6 weeks but the bottom line is diabetic foot ulcerations will not heal unless the infection is cleared.
- X-rays
- Baseline x-rays are taken to make sure that the ulceration does not extend down to bone or that any bony prominence under the ulceration is causing the ulceration.
- Serial x-rays may be taken to monitor for underlying bony changes that may signify there is a deeper bony infection that is preventing wound healing.
- Labs
- Sometimes blood work is required to help determine why a wound is not healing. Labs can be drawn to assess the glycemic control or nutritional status of a patient or help rule in or rule out infection.
- Vascular Assessment
- The basic physiology of wound healing is that the blood carries different cells and proteins to the ulceration to help create new tissue. If there is inadequate blood flow to the ulceration site the wound will be unable to heal.
- To assess the vascular status of the foot the doctor will be begin with an in-office examination of the foot to feel for pedal pulses, assess capillary refill time and warmth of the foot.
- If the foot vascular exam is abnormal the doctor may send you to get additional vascular testing done including Able Brachial Index (ABI), Arterial Duplex, toe pressures or even referral to a vascular surgeon.
- Offloading
- One of the most common reasons a diabetic wound cannot heal is that there is not enough offloading of the area to allow the ulceration to heal.
- There is a huge spectrum to offloading from simple padding devices to surgical shoe and CAM walker boots to total contact casts.
- Edema (swelling) control
- One often overlooked cause of non-healing ulcerations is lack of control of peripheral swelling. Your body is smart and it will use its path of least resistance for any extra fluid trapped in the extremities to escape. If there is an open sore on the foot the body may see this as an opportunity to drain through the sore versus having to pump that fluid against gravity back up to the heart.
- Edema control can be accomplished with compression wraps or garments, elevation, diet and sometimes diuretic therapy.
- Home health orders
- One of the issues I find a lot with diabetic wounds are that patients are unable to adequately change there dressing themselves for a variety of reasons…. They cannot reach their foot, they cannot see their foot or they are not comfortable doing their own dressing changes. Whatever the reason, sometimes home health needs to be ordered to have a nurse come to the home to help patients change their bandages and clean their wounds between doctor visits.
- Advanced wound care products
- Sometimes wound healing can stall and the body needs a little extra help to either restart the healing process or speed up the healing process.
- There have been countless advances in wound care technology in the past decade but unless you are seeing a specialist who treats wounds regularly they may not be well versed in these new products.
- Some of the advanced wound care products we use at Podiatry of Arlington Heights includes:
- Skin substitute products (STEM Cells)
- Collagen products
- Cellerate
- Extra-Cellular Matrix products
- Negative pressure vacuums
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- Drainage Management products
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For more on research on diabetic wound care and complications in Arlington Heights, IL also see: Podiatry of Arlington Heights Diabetic Wound Care Services