Foot ulcers are a common occurrence in patients with diabetes. Like other types of chronic wounds, diabetic foot ulcers are often associated with pain. As part of the treatment of diabetic foot ulcers, consideration should be given to the use of dressings that prevent wound-related trauma, minimise pain on removal, and manage infection.

15% of all diabetic patients develop foot ulceration at some stage and more than 1 in 10 foot ulcers result in an amputation. In the UK every year 5.000 people with diabetes have an amputation. It is thought that worldwide about half of all foot ulcers and amputations in people with diabetes could be prevented

/National Diabetes Support Team 2006

Among the complications of diabetes, diabetic foot syndrome (DFS) takes a prominent position. According to epidemiological surveys, it may be assumed that approximately 15 % of diabetes mellitus patients suffer from foot lesions of differing severity and characteristics during the course of their disease, and these all too often end in amputation. For classification purposes, the diabetic foot can be divided into 2 entities, the neuropathic foot and the neuroischaemic foot (Table 1)

	Neuropathic foot	Neuroischaemic foot
Anamnesis	Diabetes mellitus for many years, possibly additional alcohol consumption, further delayed damage from diabetes	Diabetes mellitus for many years, possibly lipid metabolism disruption, heart diseases, nicotine abuse and arterial hypertension
Clinical presentation
Skin colour / temperature	rosy, warm	pale to livid (position-dependent), cool
Sweating/secretion	disturbed; dry, cracked skin	atrophic skin, loss of skin appendages (hair loss)
Sensibility	reduction or loss of perception of vibration, pain, pressure, temperature, touch; reflexes impaired	unaffected, sensation present
Pain	pain at rest or at night	present, claudicatio intermittens; pain symptoms
Foot pulse	palpable	not palpable
Hyperkeratosis	frequently at sites exposed to pressure	relatively minor
Bone deformation	frequently changed bone structure, early osteolysis	rarely
Predisposed sites of lesions	foot sole, in particular in region of metatarsophalangeal joints	acral necroses

Stage Clinical Condition

The key to successful wound healing is meticulous wound care and the optimization of the body’s wound-healing capacity.

Treatment of diabetic foot ulcers

The aim of treatment for diabetic foot syndrome is primarily a reduction in amputations, preserving function in the extremities and maintaining the quality of life of the diabetic patient. Treatment is an interdisciplinary task and success is only possible with broadly spread measures. The specialists involved are internal medicine specialists, vascular surgeons, orthopaedic specialists, neurologists and dermatologists.

A primary and central problem in the treatment of diabetic ulceration is the extraordinarily high risk of infection. Only very few angiopathic lesions show no sign of surrounding infection. Mixed forms of neuropathic and angiopathic foot and purely neuropathic ulcers, however, can generally be assumed to be infected. The opportunities for spreading of an infection in the foot are particularly favourable, due to the differentiated connective tissue apparatus, so that consistent systemic antibiotic treatment is always worthwhile.

The following therapeutic principles may be formulated for the local treatment of the neuropathic ulcer:

• Absolute removal of pressure on the lesion (walking aids, wheelchair, bed rest)
• Correct wound treatment with adequate debridement and moist dressing treatment until there is complete wound closure by strong epithelium
• Treatment with suitable orthopaedic footwear
• Specialised aftercare, training of the patient and prevention of recurrence

Treatment of diabetic foot ulcers with GANIKDERMA® products

According to Clinical Investigation (EN ISO 14155): The cumulative area of diabetic wounds treated with GANIKDERMA® products was reduced by half following 30 days of treatment; after 57 days, 30.77% of the wounds healed completely, the others presenting good epithelization (with a cumulative area of 15% of the initial one).

The volume of those wounds was reduced by 50% after 6 days of treatment; following 39 days of treatment, the mean volume was 10% of the initial one, showing the great efficiency of the GANIKDERMA® products in the management of leg ulcers and diabetic foot.

During the treatment using GANIKDERMA® products no infection or foul odor were registered; the colorimetric assessment of the wound tissue (black – necrosis, black/brown dried/humid, yellow – fibrin, red – granulation tissue, pink – epithelium) during the healing process stands for the efficiency of GANIKDERMA® products  in the treatment of the chronic wounds: in all the cases the black/yellow tissue turn in red/pink tissue due to the products’ fast and efficient debridement value, with no necrosis recurrence.

On the Wong-Baker scale, the mean value of pain level during GANIKDERMA® products dressing removal was 2.32 (ignorable pain). The dressing using GANIKDERMA® products were changed at 1.35 days (mean value); the health professionals mentioned the easiness of dressing appliance/removal, with no harm to the granulation / new epithelization tissue.

Clinical cases cured with GANIKDERMA®