Monday, July 10, 2017

A Different Way of Treating Diabetic Foot Infections

Diabetic foot infection mostly healed.
Most diabetics assume they will never get a foot infection. After all, germs are carried by dirt, and if you change your socks and don’t walk around in moldy gym shoes all the time, who would expect to get an infection?

The reality is, unfortunately, that diabetic foot infections are an eventuality for many diabetics who have neuropathy, even those of fastidious foot care habits.
Every year, there are about 66,000 non-traumatic foot amputations in the United States alone. The majority of these amputations are of diabetic feet, and the predisposing complication that leads to amputation is neuropathy. About 80% of diabetics who develop foot infections also have neuropathy.

For most diabetics it isn't intuitive that neuropathy, rather than some kind of peripheral artery disease or clogging of the arteries, would lead to diabetic foot disease. It seems commonsensical that problems in circulation would lead to foot disease, but most diabetics who develop foot infections have good circulation to their feet (at least at the beginning of the infection). 

Why should neuropathy lead to foot disease? What most diabetics aren't told by their doctors is that neuropathy doesn’t just affect the nerves that transmit tactile information to the brain. It also affects the neurons that innervate the sweat glands. Diabetic feet dry out. The skin cracks. Tiny cracks in the skin admit infections that just won’t go away, and that may lead to cellulitis, sepsis, and even amputation.

Certain kinds of foot infections are more persistent than others. Staph infections tend to “hide” in blood clots and tunnel under the skin up the foot and leg. The bacteria Klebsiella pneumoniae and Proteus mirabilis form films that make it hard simply to scrub them away. Even when diabetics get over foot infections, the culprit bacteria may linger in the colon, reinfecting tiny cracks, cuts, scrapes, and abrasions in the foot when the bacteria are transferred from feces to the foot.

What can you do to prevent diabetic foot infection?

·    Don’t walk around barefoot, even inside the house. Even apparently clean floors can hold bacteria that can cause infection in tiny breaks in the skin you cannot see. Wear shower shoes if you use a public locker room. Your shoes should have a strap at the back so they don’t slip off, but leave plenty of wiggle room so you don’t develop calluses. Either Croc Clogs or Bush Sandals around the house are a good choice among many others.
· Never wear shoes with a tight toe box, but always wear shoes with a firm sole and arch support.
·         Wear socks that wick moisture away from the feet, such as Drymax , Under Armour, or Nike Dri-Max.
·         Don’t wear the same shoes every day. Allow at least 24 hours for them to dry out. This is especially important in humid climates or warm weather, or if you already have a foot infection.
·         Cleanliness is a must. Change your socks daily. Use an antiseptic spray such as Lamisil or Tinactin inside your shoes once a day to kill pathogens. Don’t use antifungal powders, since these decrease the life of your shoes.
·         Moisture is also a must. It’s essential not to allow moisture to accumulate on the skin, but it’s also essential to have moisture in the skin. Make sure feet are completely dry when coming out of the bath or shower. If you use a blow dryer, hold it at least a couple of feet (60 cm) away from your feet, or use a diffuser. Then when the surface of the skin is completely dry, apply a moisturizer over the entire surface of the foot. Eucerin is a good choice, but many herbal products are not because they contain irritant compounds. Anything that perfumes your feet may also irritate them.
·         See your doctor or podiatrist if you develop calluses. Often a callus is the result of the foot rubbing against the shoe because the free space in a toe joint is diminished. A “toe replacement” for the joint may solve the problem, or it may be necessary just to be diligent about foot care.
·         Take a vitamin D supplement. Inflammatory reactions to foot infections are greater in diabetics who have lower levels of vitamin D. Any vitamin D level below 25 nmol/l is likely to be associated with additional inflammation. Most brands of vitamin D are fine, although some “bone health” formulas don’t always provide all the vitamin D listed on the label. You’re more likely to get what the product claims if you buy a product that is just vitamin D, or just vitamin D and vitamin K2.

Same foot infection, 3 mm break in skin.
How can you recognize diabetic foot infection symptoms if doing the above doesn't turn out to be enough?

The actual break in the skin can be very slight. The photo at the left was taken of a diabetic's foot infection in ICU. The break in the skin was just 3 mm (1/8") long and less than 1 mm wide.

Diabetic foot infections often produce bizarre discoloration of the skin. It may look as if someone had spilled ink on the skin. Washing the foot doesn’t change the color of the skin. There may be a really bad odor that no amount of washing or deodorizing can mask. The foot may smell rotten – because it is.

The skin on the foot may become tender and red. Lifting the foot can become painful. The infection may spread up the foot and leg through the lymphatic system, with redness and tenderness following. Usually diabetic foot infections don’t cause raised areas of the skin, but an particularly severe infection can eat away at tissues underneath the skin. If the infection is left untreated, it can eat its way all the way to bone in just a few hours once necrotizing fasciitis has set in. This is a medical emergency. It’s always a good idea to see a doctor as soon as possible whenever you recognize the symptoms of diabetic foot infection.

What can you do to treat a diabetic foot infection? You may need medical intervention, and if there is any cellulitis (redness radiating up the foot and leg) or necrotizing fasciitis, or if you have the fever, racing heart, shortness of breath, and general flu-like symptoms of sepsis, you may have to be hospitalized. If you are not, then in addition to doctor’s orders it can be helpful to follow these steps.

·         Always take all the antibiotics your doctor prescribes, even if you are on them for months.
·         Work hard to control your blood sugar levels well enough to achieve an HbA1C of 8% or lower. This will be harder due to inactivity and the stress of the infection, but diabetics who keep their sugar levels below an average of about 180 mg/dl (10 mmol/L) have the best chances of avoiding amputation.
·         Don’t forget your appointments for debridement, the surgical removal of tissue. If you have neuropathy, this probably won’t hurt.
·         Always let the wound “breathe.” It is almost never a good idea to put a Bandaid on a diabetic foot wound. Use gauze and tape instead.
·         Treat the wound with medicinal honey. This isn’t honey that you buy at the grocery store. You absolutely should not use honey you have in your cupboard to treat diabetic foot wounds, because it can be contaminated with bacteria. Use products such as MediHoney by Derma Sciences or Eras Medicinal Sciences medicinal honey. The MediHoney product should be available for less than $10, and the Eras product for less than $20. Either product is both more effective and less expensive than “cosmeceutical” and “natural medicine” products also available in health products stores. Transfer honey from the tube to your foot. Do not touch your foot with the tip of the tube, to avoid contamination. Lightly cover the wound with gauze, changed twice a day.
·         Throw out shoes and socks that smell bad. Never wear them again. Incineration is preferable.
·         Avoid putting stress on the wound. This can be difficult if the wound is on the bottom of the foot. If you usually walk for exercise, consider using a stationary bike until the foot heals. Even after the wound heals, avoid taking unusually long walks, especially over hard pavement. It’s easy to reopen the wound, restarting a healing process that can take months.
·         Never wear tight-fitting shoes again. Sides of shoes need to be made of soft canvas or soft leather. Rocker bars reduce friction against the foot.
·         Socks should be made of cotton and be seam-free.
·         Cut toenails with a straight border. If you can’t do this yourself, see a medical professional, not a pedicurist. The danger of infection at pedicure salons is real.
·         Once the wound heals enough that you can take a bath or shower, make a habit of rinsing your feet after you have washed other parts of your body. This keeps you from transferring bacteria in your bowel to your feet.
·         The best researched herbal remedy for stimulating recovery of diabetic foot disease is Chinese, a combination of astragalus and rehmannia roots. It’s best to work with a trained herbalist if you want to use this medicine, but it may actually help stabilize the foot and sustain recovery.
·         Exercise therapy, which is something you should discuss with your doctor first, increases circulation and reduces the risk of falls. The safest exercises are done in bed. Lie down, and lift your feet off the mattress. Move your feet in every direction for 3 minutes. They should turn pink with increased blood flow. If they turn blue, do not repeat the exercise, and inform your doctor as soon as possible.
Alternative therapies you really can’t do on your own but that often work include:
·         Low-frequency ultrasound. This technique is used to reduce the area of a wound. It’s best applied about three times a week.
·         Electrical stimulation. This technique is used to stimulate circulation in the foot.
·         Laser treatment. Lasers are used to stimulate circulation and wound healing, and to relieve pain.
·         Pulsating magnetic therapy. Not the stationary “refrigerator magnet” kind of sham therapy sometimes promoted by health products vendors, pulsating magnet therapy is used to relieve pain.

Fully 80 percent of diabetics who develop foot wounds develop infections within four years. A second infection is often a prelude to amputation. The more closely you attend to foot care, the more likely you are to avoid disability in the future.

No comments:

Post a Comment