Approximately 15% of diabetics in America
will develop lower-extremity ulcers. Risk factors for developing
ulcers are abnormal pressure loading caused by neuropathy,
reduced joint mobility, ischemia, and poor glycemic control.
(1) The initial lesion in most of these cases is a painless
injury occurring in a neuropathic, insensate foot. (2)
Ulcers should be treated aggressively by a wound care specialist,
as there is an elevated risk of pain, osteomyelitis, amputation,
and diabetic sepsis. (3) Identifying the type of ulcer
(i.e. venous or arterial) is crucial when choosing a treatment
regimen. Common strategies for ulcer healing include cleansing,
wound debridement, the use of moisture retentive dressings,
and compression bandages. (4) Emphasis should be placed
on prevention and education, since there is high frequency
of recurrence. Without the use of compression stockings
as a preventative measure, a high percentage of patients
develop another venous ulcer within the first year. (5)
Diabetes poses an added risk for ulcers since diabetics
tend to develop diffused vascular
disease. Proper attention should be paid to foot care
in order to prevent ulceration. To heal the infection,
it is necessary for the body to increase blood flow to
the area that the diabetic vascular system cannot often
provide.
Compression stockings and support socks have been proven
to heal and decrease recurrence of venous leg ulcers. (6)
For prevention of diabetic ulcers, socks should be seamless,
and without holes or repairs. Tube socks do not contour
to the foot, often folding and causing irritation. The
socks should be a blend to lock away perspiration and should
be non-constricting at the calf. (7) They are not to be
used on arterial ulcers since compression can lead to reduced
blood flow and cell death. Be sure you have consulted your
physician and wound care specialist before using compression
hosiery.
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