Doctors for Diabetic Foot Ulcer Treatment

A Diabetic Foot Ulcer is a complication of diabetes in which a wound forms in the feet and develops into an ulcer due to poor blood circulation and lack of nerve functions.

In diabetic patients, open wounds and sores can easily transform into ulcers, primarily due to peripheral neuropathy (lack of sensations in the nerves in the feet) and damage to the blood vessels. Due to this, patients cannot feel pain or discomfort in the leg caused by minor injuries like cuts, blisters, or sores, and they heal slowly or don’t heal at all.

When these minor injuries go unnoticed and untreated for a significant amount of time, ulcers form which start to spread to the muscles and bones underneath. Patients who develop Diabetic Foot Ulcers have a high risk of infection if the condition is not managed properly. Ultimately, the infection can spread to the bone and may even result in tissue death, which will require amputation. Thus, Diabetic Foot Ulcers management and treatment are crucial and critical for patients’ life.

Diabetic Foot Ulcers generally initiate with an injury to the foot, such as from stepping on a nail or developing a blister from an ill-fitting shoe. When the Diabetic Foot Ulcer develops, it causes swelling, itching, and a burning sensation. However, it can become deeper and worsen if not treated, and cause severe complications.

The major types of Diabetic Foot Ulcers are:

• Neuropathic Diabetic Foot Ulcers: Neuropathic Diabetic Foot Ulcersgenerally occur as a result of loss of peripheral sensations. Neuropathic Diabetic Foot Ulcers are mostly caused by trauma or pressure that goes undetected due to a lack of sensation around pressure points.
• Its location varies depending on the patient’s circulation and appears as calloused blisters to open sores that are reddish to brown or black.
• Ischemic Diabetic Foot Ulcers: Ischemic Diabetic Foot Ulcers are caused due to poor blood flow in the legs. The narrowed arteries block the healthy flow of blood through the legs, hence, the tissues of the leg do not get proper nutrients and oxygen. This lack of nutrients causes the cells to die and the healing process gradually gets slower.
• Neuroischemic Diabetic Foot Ulcers: Neuroischemic Diabetic Foot Ulcers are found in people who have both peripheral neuropathy and ischemia resulting from peripheral artery disease. The Neuroischemic Diabetic Foot Ulcers develop on the tips of toes and beneath overly thick toenails.

To start treatment for Diabetic Foot Ulcers, it’s important to conductathorough examinationand assess the extent of the wound and the overall health of the patient. The evaluations will involve the following:

• Clinical Assessment: This assessment involves doing a comprehensive physical examination of the foot ulcer to evaluate its size, depth, and appearance of the wound. The doctor also checks for signs of infection or inflammation.
• Wound Cultures: If there are signs of infection, a wound culture may be taken to identify the specific bacteria causing the infection. This helps in choosing the appropriate antibiotics for treatment.
• X-rays : This test helps to determine if there are any underlying bone issues, such as osteomyelitis (bone infection) or fractures.
• Doppler Ultrasound: It helps to assess the blood flow in the arteries and veins in the affected foot, which identifies the blockages and reduction in blood flow.
• Ankle-Brachial Index (ABI): It is a simple and non-invasive exam to compare the blood pressure in the ankle with the pressure in the arm. It helps to determine the presence of peripheral artery disease (PAD), which can affect wound healing.
• Monofilament Test: This is a sensory test used to assess the presence of neuropathy. It involves using a thin nylon filament, which is applied to the foot to check for the ability to sense pressure. As the neuropathy increases, the risk of foot ulcers increases due to reduced sensation.
• MRI or CT Scan: If the doctor suspects that deeper tissues may be involved in the ulcer or infection from the wound has reached the bone, an MRI or CT scan will be done.
• Vascular Studies: Advanced tests like angiography or magnetic resonance angiography may be done to evaluate the blockages in the blood vessels with higher precision.
• Biopsy : In some cases, a tissue biopsy may be done to check for any malignancies in the wound or ulcer.
• Blood Tests: A complete blood test is done to assess the patient’s blood sugar levels (HbA1c), kidney function, and white blood cell count (indicating infection).

Besides the above evaluations, the doctor will also gather a detailed medical history of the patient, including diabetes duration, blood sugar control measures, previous ulcers, and current medications. The doctor also evaluates the patient’s overall nutritional status (to check for nutritional deficiencies) and asks about any underlying medical conditions, such as cardiovascular diseases, etc., that can impact the healing abilities.

Based on the information gathered from the above-mentioned diagnostic tests and evaluations, a personalized treatment plan is developed for Diabetic Foot Ulcers. A multidisciplinary team consisting of wound care specialists, vascular surgeons, endocrinologists, and infectious disease specialists may be needed for Diabetic Foot Ulcer management and treatment.

The diagnostic process is comprehensive and aims to identify and address all factors contributing to Diabetic Foot Ulcers. Treatment plans are tailored to the patient's specific needs to promote healing, prevent complications, and reduce the risk of future ulcers.

To start treatment for Diabetic Foot Ulcers, it’s important to conductathorough examinationand assess the extent of the wound and the overall health of the patient. The evaluations will involve the following:

• Clinical Assessment: This assessment involves doing a comprehensive physical examination of the foot ulcer to evaluate its size, depth, and appearance of the wound. The doctor also checks for signs of infection or inflammation.
• Wound Cultures: If there are signs of infection, a wound culture may be taken to identify the specific bacteria causing the infection. This helps in choosing the appropriate antibiotics for treatment.
• X-rays : This test helps to determine if there are any underlying bone issues, such as osteomyelitis (bone infection) or fractures.
• Doppler Ultrasound: It helps to assess the blood flow in the arteries and veins in the affected foot, which identifies the blockages and reduction in blood flow.
• Ankle-Brachial Index (ABI): It is a simple and non-invasive exam to compare the blood pressure in the ankle with the pressure in the arm. It helps to determine the presence of peripheral artery disease (PAD), which can affect wound healing.
• Monofilament Test: This is a sensory test used to assess the presence of neuropathy. It involves using a thin nylon filament, which is applied to the foot to check for the ability to sense pressure. As the neuropathy increases, the risk of foot ulcers increases due to reduced sensation.
• MRI or CT Scan: If the doctor suspects that deeper tissues may be involved in the ulcer or infection from the wound has reached the bone, an MRI or CT scan will be done.
• Vascular Studies: Advanced tests like angiography or magnetic resonance angiography may be done to evaluate the blockages in the blood vessels with higher precision.
• Biopsy : In some cases, a tissue biopsy may be done to check for any malignancies in the wound or ulcer.
• Blood Tests: A complete blood test is done to assess the patient’s blood sugar levels (HbA1c), kidney function, and white blood cell count (indicating infection).

Besides the above evaluations, the doctor will also gather a detailed medical history of the patient, including diabetes duration, blood sugar control measures, previous ulcers, and current medications. The doctor also evaluates the patient’s overall nutritional status (to check for nutritional deficiencies) and asks about any underlying medical conditions, such as cardiovascular diseases, etc., that can impact the healing abilities.

Based on the information gathered from the above-mentioned diagnostic tests and evaluations, a personalized treatment plan is developed for Diabetic Foot Ulcers. A multidisciplinary team consisting of wound care specialists, vascular surgeons, endocrinologists, and infectious disease specialists may be needed for Diabetic Foot Ulcer management and treatment.

The diagnostic process is comprehensive and aims to identify and address all factors contributing to Diabetic Foot Ulcers. Treatment plans are tailored to the patient's specific needs to promote healing, prevent complications, and reduce the risk of future ulcers.

Surgery for Diabetic Foot Ulcers may be necessary when conservative treatments fail to promote healing or there are complications such as severe infection, extensive tissue damage, or underlying bone involvement. Surgical interventions aim to remove infected or dead tissue, improve blood flow, and enhance wound healing.

Some common surgical approaches for Diabetic Foot Ulcer Treatment are listed below:

• Debridement Surgery: It is a procedure that involves the removal of the hyperkeratotic tissue, fibrin, biofilm, and necrotic tissue from the ulcer wound to facilitate healing. With this technique, the wound-healing process can be initiated by the small vessels that transport fresh blood to the edges of the debrided wound.
• Revascularization or Vascular Reconstruction/Restoration: This surgical approach involves performing either angioplasty or bypass surgery. In angioplasty, the blocked or narrowed blood vessels are opened up by placing a stent or balloon catheter. If the arteries are blocked, a vascular bypass surgery is performed to create an alternative route to restore blood flow to the wound.
• Flap Surgery: This approach involves transferring a section of healthy skin, along with its underlying blood vessels, from one area of the body to the wound site. This is particularly useful for large or complex wounds.
• Joint Fusion or Removal: In cases where an infected joint is contributing to the ulcer, joint fusion (arthrodesis) or removal (joint disarticulation) might be considered to eliminate the infection source.
• Osteomyelitis Surgery: In case of bone infection, surgery may be done to remove the infected bone tissues to prevent the infection from spreading.
• Amputation : In cases where the ulcer is extensive, severe infection is present, or blood flow cannot be restored, partial or full amputation of the affected toe, foot, or leg might be necessary to prevent the spread of infection and save the patient's life.

It should be noted that surgical interventions are often a part of a comprehensive treatment plan that includes managing diabetes, optimizing wound care, and addressing the contributing factors. The decision regarding Diabetic Foot Ulcer surgical treatment is typically made after discussing the treatment options with the respective specialists and the patient.

The specific steps that need to be followed for preparation prior to Diabetic Foot Ulcer surgical treatment vary from one patient to another, depending on the plan of treatment. The common preparation instructions patients will receive from the doctor include the following:

• Manage the blood sugar levels in the weeks leading up to the surgery to reduce the risks and complications.
• Eat a balanced diet rich in nutrients, vitamins, and protein to support wound healing. Also, stay hydrated by drinking plenty of water and other fluids.
• Provide a list of medications to the doctor so that he/she can adjust them or recommend to stop taking specific medications that can increase the risks of surgery.
• Patients are advised to quit smoking entirely as it impairs blood circulation and hinders wound healing.
• Keep the foot dry and clean to prevent infection. Also, inspect the foot daily to look for new cuts, sores, and injuries. Notify the surgeon immediately if a new wound develops.

On the day of surgery, the patient will receive additional instructions, such as:

• Practice fasting, i.e., avoid drinking and eating for a specified period before the surgery.
• Take only the prescribed medications approved by the doctor with a small quantity of water.
• Shower or bathe before the surgery using an antibacterial soap prescribed by the surgeon.
• Avoid applying moisturizers or lotions to the feet on the day of surgery.
• Wear loose and comfortable clothes to the hospital that can be easily removed without rubbing against the foot.
• Avoid wearing jewelry and other accessories, including toe rings, anklets, etc.
• Arrange for transportation to and from the hospital on the day of surgery.
• Bring all the necessary documentation, including ID card, insurance card, diagnostic test reports, etc.

Upon arrival at the hospital, the patient will undergo a pre-operative assessment that will involve vital signs evaluations and blood tests. Besides these, the right type of anesthesia is also chosen for the patient after discussion regarding allergies and adverse reactions in the past.

Recovery after Diabetic Foot Ulcer Treatment varies based on the severity of the ulcer and the chosen treatment approach. The estimated recovery timeline will be around 1 to 3 months and can be longer if the patient requires further intervention. The general recovery timeline will be as below:

• Initial Healing Phase: In the immediate post-treatment period, the wound needs to be closely monitored for signs of infection or delayed healing. Dressings may need to be changed regularly to maintain a clean and healing environment. There will be significant swelling, redness, and bruising in the treated area, which will start to subside after 1-2 weeks.
• In 1-2 Weeks: As the wound heals, any pain or discomfort associated with the ulcer should gradually subside. The patient will require a follow-up to monitor the recovery and adjust medications as suitable to ensure proper healing.
• Within 3-4 Weeks: Over the course of several weeks, the wound should gradually heal, with the edges coming closer together and new tissue forming. If offloading devices were used, patients may need to continue using them until the wound is fully healed to prevent pressure on the area.
• After 1 Month: Depending on the treatment approach, patients may gradually be allowed to bear weight on the treated foot or ankle. Physical therapy or rehabilitation exercises may be recommended to restore strength and mobility in the affected foot.
• In the Upcoming Months: Effective blood sugar control remains essential during recovery to support the wound healing process and prevent future ulcers. Patients are also educated on the importance of proper foot care, regular inspections, hygiene, and footwear. Even after the wound heals, the patient may be advised to use silicone gel, sheets, and specialized creams to improve the appearance of the scar.

The recovery timelines can vary based on individual factors. Due to this, some patients may recover faster than others.

While Diabetic Foot Ulcer Treatment aims to promote healing and prevent complications, there are several risks and complications that can arise during or after the surgery. These can vary depending on the severity of the ulcer, the effectiveness of the treatment, and the individual patient's health. Some of the potential risks and complications include:

• Infection : Despite treatment, Diabetic Foot Ulcers can become infected. Infection can spread rapidly, leading to cellulitis, abscess formation, or even sepsis.
• Delayed Healing: Some ulcers may not heal as expected, requiring additional treatments or interventions.
• Recurrence : Even after successful treatment, new ulcers can develop if preventive measures are not followed or underlying issues are not addressed.
• Amputation : In severe cases, especially if infection cannot be controlled or blood flow is compromised, amputation of part of the foot or leg might be necessary.
• Scarring : Improper wound care or healing can result in unsightly or hypertrophic scars.
• Nerve Damage (Neuropathy): Some treatments may inadvertently damage sensory nerves, leading to altered sensation or neuropathic pain.
• Vascular Complications: Vascular interventions may lead to complications like bleeding, blood clot formation, or damage to blood vessels.

Patients are given proper advice pre-and-post operation to reduce the risks and complications. Still, some complications can occur and are likely to require timely intervention. That’s why patients are advised to follow the doctor’s instructions carefully, look out for the signs of complications, and report them right away.

If the patient was not already following the precautions and guidelines of the doctor to manage diabetes prior to developing ulcers, he/she would be strictly advised to comply with the guidelines after the treatment. The patient will need to make significant lifestyle changes for the prevention of Diabetic Foot Ulcers. The general guidelines to improve the patient’s health and prevent foot ulcers from recurrence include the following:

• Dietary Modifications
• One of the key aspects of managing diabetes is eating a healthy and balanced diet. Patients will need help from a dietitian to create a meal plan that provides ample nutrition and keeps the glycemia regulated. The dietary guidelines include the following:
1. Add fruits to the diet that are full of essential vitamins, minerals, and other nutrients, such as oranges, grapefruits, lemons, berries, melons, bananas, grapes, apples, etc.
2. Prefer eating green leafy vegetables as they have minimal impact on the blood sugar levels. Include spinach, collard greens, kale, cabbage, bok choy, broccoli, etc.
3. Eat protein-rich foods, such as lean meat, chicken, fish, eggs, nuts, dried beans, peas, and meat substitutes like tofu.
4. Cut down or take limited portions of foods that have a low glycemic index (GI) and pair them with healthy fats or protein to fulfill the hunger.
5. Limit or avoid intake of refined sugar, including homemade sweets, cakes, and biscuits. Also, avoid sugary drinks, especially energy drinks, as they contain excess amounts of sugar, which can affect insulin levels.
6. Drinking alcohol can increase the individual’s risk of hypoglycemia. Either reduce alcohol intake or avoid it completely.
7. Smoking is strictly prohibited for diabetic patients as they already have poor circulation, and smoking can intensify ulcers by further damaging the blood vessels and reducing circulation.

• Foot Care
1. Diabetic patients should examine their feet daily, especially if they have peripheral neuropathy. Look between the toes to check for fungal infection and the foot for skin breaks, blisters, cuts, scratches, etc.
2. Wash feet properly with antibacterial soap and keep them dry but moisturized. Excessive dryness can increase the risk of callus and corn formation, whereas excessive moisture will increase the risk of bacteria accumulation.
3. Always check the temperature of water while cleaning or soaking feet. Diabetic patients with neuropathy can’t detect the temperature in their extremities, which increases the risk of accidental burns.
4. Wear the right-sized footwear that doesn’t constrict the blood flow, and use stockings or socks that are clean.
5. Avoid activities that can injure the foot, including walking barefoot, using heat pads, etc.
6. Be careful while trimming the toe nails. Avoid cutting them too short, and don’t leave sharp edges that can scratch the skin.
7. Don’t leave an in-grown nail or callus untreated for a long time.

Besides following these instructions, patients are also advised to get regular examinations for the prevention of Diabetic Foot Ulcers.

The cost of Diabetic Foot Ulcer surgical treatment in India ranges from Rs. 40,000 to Rs. 2,50,000. However, it is only an estimated cost range that varies for each patient, depending primarily on the diabetic foot ulcer stage. Additional key factors that influence the cost of treatment are listed below:

The severity of the condition and extent of damage done to the deep veins, muscles, and bones.

The method chosen to treat the ulcer (surgical or non-surgical).

The surgeon’s consultation and operating fees.

Diagnostic tests are performed before and after surgery.

Medications prescribed to the patient.

The choice of hospital and hospitalization expense.

Post-surgery care and follow-up consultations.

The overall cost of treatment is calculated based on the above-listed factors. The good thing is that Diabetic Foot Ulcer Treatment is covered under insurance as it is a critical condition. The treatment is deemed a medical necessity. Thus, patients only need to file a claim request to acquire authorization, and the insurance company will cover the expenses entirely or partially as specified in the policy.

After Diabetic Foot Ulcer Treatment, several outcomes and expectations can be anticipated based on the effectiveness of the treatment and the individual patient's condition.

General things patients can expect immediately after the treatment include the following:

• Pain and Swelling: There will be considerable swelling in the treated area and mild to moderate pain, which will be managed by medications. However, the patient will get relief from pain caused by the slow-healing ulcers.
• Anesthesia Side-Effects: Patients may experience nausea, concentration issues, dizziness, dry mouth, sore throat, blurry vision, and numbness for several hours after the anesthesia wears off.
• Immobility : Initially, the patient will not be able to walk for several days. Once the wound starts to heal, the mobility will improve, and the patient will be able to walk without pain or restrictions.
• Overnight Monitoring: While treating early-stage Diabetic Foot Ulcers, the patient will be discharged on the same day. But in severe cases, patients can expect an overnight stay so that the doctor can monitor the surgery’s outcome.
• Diabetes Management Measures: The patient will be given a detailed guide to manage diabetes and prevent foot ulcers from forming again after surgery.
• Physical Therapy: Most patients who have experienced limb injuries require physical therapy to regain proper functioning and control.

Before discharge, the patient will receive detailed post-op care instructions and a follow-up schedule. If additional treatment is required, the patient will be given a timeline for that, too.

There are several non-surgical options for Diabetic Foot Ulcer Treatment, which are effective and often used in combination with surgical procedures to improve the outcome and help patients heal. The commonly used methods are listed below:

• Offloading:
• Offloading is usually the first line of treatment for Diabetic Foot Ulcers. It means relieving the pressure from an ulcerated area through external means or support. It requires the patients to stay off the foot to avoid applying pressure to the ulcer and prevent it from getting worse.
• External devices that are commonly used to take the load off the affected foot are specially designed footwear, casts, foot braces, compression wraps, and shoe inserts.
1. Cast Devices: They are the most commonly used and effective method to reduce the load and stress on the affected foot. They are mostly used for forefoot and mid-foot ulceration. If the patient has an infected wound, ischemia, and poor balance, alternative methods of offloading will be considered.
2. Total Contact Casting (TCC): It is another popular non-surgical method to treat early-stage Diabetic Foot Ulcers. In this method, a below-knee cast is used that encases the entire lower limb and the foot. It is considered a gold standard for offloading for forefoot and midfoot ulcers.
3. Shoe Inserts: These are special devices that help to redistribute the body weight across the bones and joints equally. These inserts are firm but soft to support the foot and make walking easier and more comfortable. As the pressure is relieved, the ulcer will start to heal, providing relief from the symptoms.
4. Foot Braces: If an excessive load needs to be taken off the foot due to underlying deformity, a custom-made foot brace may be provided for the patient. The common types of foot braces are Control Ankle Motion Walkers, Pneumatic Walkers, Arizona Ankle-foot Orthosis, and Patella-tendon-bearing Orthosis. These braces shift the body weight from the affected area of the foot onto the strong tendon.
• Hyperbaric Oxygen Therapy:
• This treatment can be effective to a great extent in improving the healing of Diabetic Foot Ulcers. A chamber is used where the patient lies on his/her back on a bed. The chamber is filled with 100% oxygen which increases the amount of oxygen in the bloodstream ten times.
• This speeds up the healing of the ulcer by stimulating the growth factors and stem cells. Sometimes, multiple sessions are done of this therapy to ensure that the wound heals properly. It should be noted that hyperbaric oxygen therapy may not be available at all medical centers.
• Non-Surgical Debridement:
• There are several alternative methods of debridement that do not involve the usage of surgical equipment. The success rate of each of the above-listed debridement methods varies as the patient may respond to these treatments differently.
• The various methods are listed here:
1. Autolytic Debridement: In this method, the patient’s own enzymes are used in the form of hydrocolloids, hydrogels, or transparent films to rehydrate, soften, and liquefy the necrotic tissues. It is a selective treatment that targets only the non-viable tissues and doesn’t affect the healthy tissues.
2. Enzymatic Debridement: In this type of debridement, chemical enzymes derived from microorganisms are used to remove the dead skin from the ulcer. Common microorganisms used for this are clostridium, histolyticum, papain, varidase, bromelian, etc.
3. Mechanical Debridement: Hydrotherapy is used in mechanical debridement. It involves wound irrigation using a syringe and catheter tube, which washes away the dead tissues.
4. Maggot Therapy: This method involves using a special type of disinfected maggots that eat away the dead tissues and produce chemicals that promote wound healing. It is used to clear chronic wounds.
• Ointment and Creams:
• Several ointments and creams may be prescribed or recommended for the treatment of Diabetic Foot Ulcers. These products are often used to promote wound healing, prevent infection, and create an optimal environment for tissue regeneration.
• The specific ointment or cream prescribed can vary based on the characteristics of the ulcer and the patient's individual needs. The choice of cream or ointment for diabetic foot ulcers depends on factors such as the wound's condition, presence of infection, wound depth, and patient allergies. The doctor will assess these factors to determine the most appropriate topical ointment or cream.
• Here are some common examples of prescribed creams and ointments for Diabetic Foot Ulcers:
1. Neosporin, Bactroban (mupirocin), and Silver sulfadiazine are the commonly used Diabetic Foot Ulcer antibiotic creams to prevent or treat infection by controlling bacteria on the wound surface.
2. Curafil Gel and DuoDERM Hydroactive Gel are effective hydrogel ointments that maintain a moist wound environment, facilitate debridement, and promote tissue healing.
3. Betadine (povidone-iodine) and Chlorhexidine are the two most commonly used topical antiseptics that help to prevent infection by reducing bacteria and microorganisms in the wound.
4. Promogran Prisma is a collagen-based cream that provides a scaffold for tissue regeneration, promotes wound healing, and helps manage excess exudate.
5. Santyl is another commonly prescribed enzymatic ointment that assists in debridement by breaking down and removing the necrotic tissues.
6. Regranex (becaplermin) is a growth factor ointment that is used to stimulate the growth of new tissue and support wound healing.
7. Petroleum Jelly (Vaseline) is also suggested to use to keep the wound moisturized and prevent dryness, which aids in healing.
8. Zinc oxide ointment, such as Bacitracin zinc, may be prescribed to protect the skin, promote wound healing, and help prevent infection.
9. Silver-containing ointments, such as Silvadene (silver sulfadiazine) and Acticoat, are also prescribed as they have antimicrobial properties and help to manage bacterial growth in the wound.
• Home Remedies:
• Some common home remedies that diabetic patients often try to heal foot ulcers include the following:
1. Flaxseed Oil: Regular use of flaxseed oil can help to repair vascular damage. The seeds from which the oil is created are rich in omega-3 fatty acids, which are effective in repairing blood vessels and improving vascular function to promote healing.
2. Vitamin C and E: The regular intake of vitamin C and E in limited amounts can be beneficial for diabetic patients and reduce the ulcer size effectively.
3. Zinc : Foods that are rich in zinc are also considered good for patients as they improve the production of insulin, which manages blood sugar levels and increases the healing process.
4. Honey : It is a safe natural home remedy known to inhibit bacterial growth in the ulcer. Honey also reduces the recovery time of the wound by accelerating granulation.
5. Aloe Vera: This home remedy is very popular and considered effective in providing temporary relief from the discomfort associated with diabetic foot ulcers. Aloe vera has antibacterial properties that help to kill bacteria in the wound and speed up the healing. The aloe vera gel can be applied directly to the wound, or patients can drink aloe vera juice to improve healing abilities.
6. Tea Tree Oil: This oil has incredible antibacterial properties and is very effective in fighting infection. It is often used in combination with coconut oil, which also has healing properties.
• These home remedies for Diabetic Foot Ulcer Treatment may or may not work for all patients. And even when they do work, the effects will only last as soon as the patient continues to use them. Thus, instead of recommending home remedies, patients are often advised to consult a specialist and use the treatment method suggested by them.
• Medications:
• Several medications are prescribed to patients who are diagnosed with Diabetic Foot Ulcers. The particular medications given to the patient will depend on the initial diagnosis and severity of the condition. In most patients, the following medications are used in combination with or without surgical intervention to prevent the condition from getting worse.
1. Antibiotic Medications: In most patients, Diabetic Foot Ulcers easily become infected due to the compromised immune system and peripheral neuropathy. If so, patients are prescribed antibiotics, such as vancomycin, aztreonam, metronidazole, piperacillin, amoxicillin, clindamycin, ampicillin-sulbactam, doxycycline, ertapenem, etc. The right type of antibiotic is chosen by the doctor after determining the cause of the infection. These Diabetic Foot Ulcer antibiotic medicines can be used alone or in combination with each other as required.
2. Antiplatelet Agents: Medications like aspirin or clopidogrel (Plavix) are used to prevent complications of atherosclerosis (which occurs when high cholesterol levels increase plaque buildup in arteries and veins, resulting in clogging). The medicine works by inhibiting platelet function and preventing the risk of blood clots.
3. Hemorrheologic Agents: These medications are prescribed to patients when they experience intermittent claudication (cramp-like pain in the calf muscles). Typically, pentoxifylline (Trental) or cilostazol (Pletal) are the medications used to increase the blood flow in the arteries. The patients are usually advised to take the medicine for 2 to 8 weeks to improve the pain in the affected foot.
4. Wound Healing Agents or Growth Factors: This medication is available in gel form and applied topically to the wound or ulcer to promote healing. The commonly used healing agent is becaplermin gel (0.01%), which is obtained from platelets through genetic engineering. This medicine is approved by the FDA and is effective in healing ulcers without necrosis.

The outcome of Diabetic Foot Ulcer Treatment is measured in terms of wound healing, mobility, relief from symptoms, and functional restoration of the affected limb. The potential outcomes and results will be as follows:

• Wound Healing: The primary goal of surgery is to promote wound healing. Successful surgery should lead to the closure of the ulcer and the regeneration of healthy tissue.
• Reduced Infection Risk: Surgery removes infected tissue, reducing the risk of further infection and complications.
• Pain Relief: Surgery can alleviate pain associated with the ulcer by removing sources of irritation and infection.
• Improved Mobility: If the surgery’s outcome is good and the wound is healing properly, the patient will have improved mobility and will be able to walk without pain or discomfort.
• Functional Restoration: If deformities were corrected during surgery, functional limitations may be improved, enhancing the patient's quality of life.

The results of Diabetic Foot Ulcer Treatment can vary depending on factors such as the severity of the ulcer, the chosen surgical approach, the patient's overall health, and their adherence to post-surgery care instructions.