Diabetic foot ulcer is one of the majorcomplications of Diabetes mellitus. It occurs in 15% of all patients withdiabetes and precedes 84% of all lower leg amputations. Diabetics are prone tofoot ulcerations due to both neurologic and vascular complications.

Pathophysiology- Pressure over a bony prominence has oftenbeen cited as the cause for skin breakdown in patients with diabetes. Skinbreakdown occurs at far lesser loads when the pressure is applied by shearforces. The accompanying loss of protective sensation prevents the patient frombeing warned that intolerable loads have been applied. This leads to blisterformation and full-thickness skin loss. The process is heightened in thepresence of severe venous swelling, which further lowers the injury threshold.Shoes become tight due to swelling, thus increasing the direct pressure andshear forces applied to skin overlying the bony prominence. Thickened,hypertrophic nails increase pressure on the soft tissues surrounding the nails.The common result is tissue failure and ulcer formation.
Once the skin barrier is broken, wound healing can be impairedby abnormally functioning WBCs. Moreover, patients often are malnourished. Manyhave a marginal vascular supply, with less ability to achieve resolution ofinfection and wound healing.
Several risk factors increase a person with diabetes chancesof developing foot problems and diabetic infections in the legs and feet.
Footwear: Poorly fitting shoes are a common cause of diabeticfoot problems.
If the patient has red spots, sore spots, blisters, corns,calluses, or consistent pain associated with wearing shoes, new properlyfitting footwear must be obtained as soon as possible.
If the patient has common foot abnormalities such as flatfeet, bunions, or hammertoes, prescription shoes or shoe inserts may benecessary.
Nerve damage: People with long-standing or poorly controlleddiabetes are at risk for having damage to the nerves in their feet. The medicalterm for this is peripheral neuropathy.
Because of the nerve damage, the patient may be unable to feeltheir feet normally. Also, they may be unable to sense the position of theirfeet and toes while walking and balancing. With normal nerves, a person canusually sense if their shoes are rubbing on the feet or if one part of the footis becoming strained while walking.
A person with diabetes may not properly sense minor injuries(such as cuts, scrapes, blisters), signs of abnormal wear and tear (that turninto calluses and corns), and foot strain. Normally, people can feel if thereis a stone in their shoe, then remove it immediately. A person who has diabetesmay not be able to perceive a stone. Its constant rubbing can easily create asore.
Poor circulation: Especially when poorly controlled, diabetescan lead to accelerated hardening of the arteries or atherosclerosis. Whenblood flow to injured tissues is poor, healing does not occur properly.

Trauma to the foot: Any trauma to the foot can increase therisk for a more serious problem to develop.

Athlete's foot, a fungal infection of the skin or toenails,can lead to more serious bacterial infections and should be treated promptly.
Ingrown toenails should be handled right away by a footspecialist. Toenail fungus should also be treated.
Smoking: Smoking any form of tobacco causes damage to thesmall blood vessels in the feet and legs. This damage can disrupt the healingprocess and is a major risk factor for infections and amputations. Theimportance of smoking cessation cannot be overemphasized.

1.History and physical examination- this include symptoms ofthe patient along with complete examination which include the patient's vitalsigns (temperature, pulse, blood pressure, and respiratory rate), examinationof the sensation in the feet and legs, an examination of the circulation in thefeet and legs, a thorough examination of any problem areas.
2.Laboratory test- it include complete blood count, bloodsugar, kidney function test.
3.X-ray- x-rays studies of the feet or legs to assess for signsof damage to the bones or arthritis, damage from infection, foreign bodies inthe soft tissues.
4.Doppler ultrasound to see the blood flow through thearteries and veins in the lower extremities.

Medications to reduce intensity of the symptoms, furtherinfection.
Wound care- proper hygiene should be maintained.
Diabetes must be controlled.
Ill fitted footwear should be avoided.
Exercise should be regularly done in order to improve bloodflow.

Role of homoeopathy
There are several medicines available in homoeopathictherapeutics which helps in healing wound and prevent amputation. Thoseindividuals who experience pain are prescribed Homeopathic Treatment whichsignificantly relieve pain and burning sensation as well as remedies whichreduce edema, tendonitis and especially improve peripheral circulation.

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