Ulcer in the Foot – Diabetic Foot Ulcer Stages
When dealing with diabetic foot ulcers, it’s crucial to have an understanding of the natural progression of diabetic foot disease, which can be classified into five stages. These stages include: a normal foot, a high-risk foot, an ulcerated foot, an infected foot, and a necrotic foot. The development of a foot ulcer is a significant event in stage 3 and requires urgent and aggressive treatment.
Proper management of diabetic foot care across all stages requires a multidisciplinary approach to address mechanical, wound, microbiological, vascular, metabolic, and educational aspects. Maintaining good control of blood glucose, lipids, and blood pressure is essential in every stage, as is educating patients on proper foot care appropriate for each stage.
Early Stage Diabetic Foot Ulcer
Ideally, preventing the development of ulcers should be the primary focus during stages 1 and 2. In stage 1, encouraging the use of suitable footwear and educating patients on healthy foot care and footwear habits is critical. In stage 2, patients have developed one or more risk factors for ulceration, including neuropathy, ischaemia, deformity, swelling, and callus. Most deformities can be accommodated in special footwear, and callus should be treated aggressively, particularly in the neuropathic foot.
Middle Stage Ulcer on the Foot
During stage 3, ulcers can be classified into two categories: those in the neuropathic foot and those in the neuroischaemic foot. In the neuropathic foot, ulcers commonly occur on the plantar surface of the foot and toes and are associated with neglected callus and high plantar pressures. In the neuroischaemic foot, ulcers are typically seen around the edges of the foot and are associated with trauma or wearing unsuitable shoes. Relief of pressure, sharp debridement and dressings, and possibly vascular intervention for neuroischaemic foot ulcers are necessary for proper treatment.
Final Stage Ulcer
In stage 4, microbiological control is crucial, and severe infections require intravenous antibacterial therapy and prompt assessment for surgical drainage and debridement. If left untreated, severe infections may progress to necrosis in stage 5, which can be classified as wet or dry necrosis. Aggressive management, including intravenous antibacterials and surgical debridement, is necessary for treating wet necrosis in neuropathic feet, and vascular reconstruction is often required for neuroischaemic feet. Effective management of diabetic foot ulcers can help reduce the number of feet that progress to infection and necrosis, ultimately decreasing the number of major amputations in diabetic patients.
