Diabetic patients often suffer from continued foot problems, including heel fissures and diabetic ulcers. Over time, a diabetic patient's circulation becomes compromised due to the hardening and narrowing of the blood vessels in the feet and legs. Poor circulation in combination with high-pressure areas on the bottom of the foot can lead to callous formation. If not properly treated, the callous can lead to an ulcer. Currently it is estimated that within the United States nearly 20% of diabetic ulcers will result in  amputation. These ulcers can be difficult to heal due to inadequate blood flow and increased risk of infection.*

Prevention is the best medicine when it comes to diabetic foot care. Heel fissures, are caused by  recurrent callous formation and can be treated with  a compounded topical medication that aims to moisturize the area and promote healing. A cream that  has often been prescribed contains clobetasol, terbinafine, econazole and urea and is applied to the heels every night for 2 weeks, then prn to help prevent these fissures from becoming ulcers. Proper hygiene as well as good nutrition is also essential in promoting healing.

Wound care is one of the foremost concerns of patients with diabetes. Primary problems that make diabetic ulcers difficult to heal include inadequate blood flow to the wounded areas and increased risk of infection. Thus, treatment of wounds in the diabetic patient must address rapid  granulation, increased circulation, and prevention of  infection. All of these concerns can be addressed with the use of  customized topical medications.

These preparations include calcium channel blockers which are proven to have a versatile and important role in the treatment of wounds. Topical calcium channel       antagonists, such as nifedipine, have been shown to hasten wound healing and reduce scar formation. It is theorized that transdermal nifedipine can cause smooth muscle relaxation by preventing calcium influx, which may lead to increased blood flow and vascularization. Pentoxyphylline is a phosphodiesterase inhibitor that acts to  reduce blood viscosity and thus improve circulation. It is thought to reduce scar formation by  interfering with the production of collagen and  proteoglycans.

Phenytoin has traditionally been used as an anticonvulsant. One of its classic side effects is gingival hyperplasia, and this is the basis behind the hypothesis that topical phenytoin can stimulate wound repair. Misoprostol is  often added to prevent tissue breakdown. For painful  lesions, a topical anesthetic such as lidocaine may be included. In case of infection, antibiotics such as metronidazole are added.*

Pharmacy Innovations compounds topical preparations for treating diabetic foot ulcers in many different combinations and strengths, depending on the individual patient's needs. For more information on treating your diabetic patient, contact our nearest pharmacy or visit our website at www.pharmacyinnovations.net.

 * International Journal of Pharmaceutical Compounding Vol 8 No