Physiotherapy Treatment of Diabetic Ulcers

Physiotherapy Treatment of Diabetic Ulcer 

 Physiotherapy Aims

·        To relieve pain

·        To relieve edema

·        To prevent infection

·        To promote healing and improve circulation

·        To mobilize soft tissues at the edges and floor of the ulcer

·        To improve joint mobility and strengthen the weakened muscles

·        Prevent scar formation adhesions and other complications

·        To improve the condition of the skin in lower limb

Means of Physiotherapy Management

 1. Faradism under pressure

·        Faradism under pressure

·        Pneumatic compression bandages and elastic stockings

·        Elevation of the limb

·        Manual massage techniques

·        Ultrasound therapy (pulsed mode)

·        Soft tissue techniques

2. To control infection and promote healing

 a. Ultrasound therapy

 Uses:

·        Promote healing

·        Soften the indurations

·        Improve blood supply

·        Frequency: 3 MHz

·        Mode: Pulsed mode (acute ulcers) and continuous mode (chronic ulcers)

·          Intensity: 0.2 – 0.6 W/cm2

·        Duration: 2-6 mins

 b. Ultraviolet radiations

For infected wounds

·        It helps to destroy micro-organisms and improve circulation and promote skin growth

·        Kromayer lamp is commonly used

·        E4 dose or E4x2 dose for base of ulcer

·        E1 or E0 dose for edges of ulcer

·        For 2/3 times per week

 For healing ulcers

·        E1 dose (shallow ulcers)

·        E2 dose (for deep ulcers)

·        E1 or E0 dose for edges of ulcer

·        It helps to stimulate the growth of granulation tissue

 For indolent ulcers

·        E3 dose for the floor of ulcer

·        E1 or E2 dose for edges of ulcer

·        It helps to improve circulation and promote healing of ulcer

c. Pulsed electromagnetic energy: (PEME) It is the production of short bursts of high frequency current Pulse width: 65 us Frequency: 400 pulses/min Duration: 30 mins

Uses

·        Increased growth of epithelial and connective

·        Promote healing

·        Provides non-thermal effects

·        Improves circulation

d. Ionozone therapy It is the production of steam which is passed over a mercury arc and into a mixture of ionized water, ozone and O2 Distance: Applied 30 cms away from ulcer Duration: 10-2- mins

Uses:

·        Promotes healing

·        Prevents infection

·        If UVR treatment is not effective

·        Reduces pain

e. LASER (Light Amplification by Stimulated Emission of Radiation)

·        Visible red laser is used (600-950nm)

·        Promotes healing by proliferation of fibroblasts

·        Causes vasodilatation thus improves circulation

f. Infrared Rays (IRR)

·        For 20 mins at a distance of 50-70 cms

·        Promotes wound healing and improves circulation

  

3. To mobilize soft tissue structures

·        Manual massage techniques

·        Thumb and finger kneading from periphery up to location of ulcer

·        Modified petrissage, picking up and rolling

·        Moving the ulcer from side-side

·        These techniques are not given when the ulcer is infected

·        The limb should be elevated to 450 while giving manipulation techniques

Uses

·        Improves circulation

·        Drainage of exudate and tissue fluid

·        Improve skin texture

·        Reduce edema and congestion

4. To mobilize the joints and strengthening of muscles

·        Active exercises of the involved joint

·        Elastic bandages must be worn

·        Free exercise to maintain joint ROM

·        Walking and gait training exercises

·        Emphasizing on push off‖ while walking

·        Isometric exercises

·        Progressive resisted exercises

·        To improve functional training treadmill, cycling is done

5. General advice to the patient

·        Avoid exposure to infectious environment

·        Maintain personal hygiene

·        Sterile dressings are applied

·        Avoid standing for prolonged time

·        Elevate the limb with pillows while sitting or sleeping