Honey-Based Dressings: Can They Have An Impact For Diabetic Foot Ulcers?
Honey is an ancient wound remedy that is reappearing in clinical practice in developed countries. The availability of licensed wound care products in Europe, New Zealand and Australia is prompting healthcare practitioners in conventional medicine to consider the use of honey within their treatment armamentarium. Ulcer remedies such as honey are necessary as the prevalence of diabetes rises.
The American Diabetes Association has estimated that about 7 percent of the population had diabetes.1 It is an increasing problem that has serious implications and a high degree of morbidity. In 2005, 1.5 million new cases in the U.S. were diagnosed in people over 20 years of age.
Foot ulcers are a frequent and complex complication in diabetes and researchers have estimated the prevalence of foot ulceration in this population to be approximately 6 percent.2 Diabetic foot ulcers are often present for long periods of time and have poor healing rates.3 These poor healing rates lead to the worst case scenario — amputation — and diabetes remains the most common cause of lower extremity amputation in the Western world.
There are a variety of factors that lead to the development of ulceration in the diabetic foot. In addition to complex sensory, motor and autonomic neuropathy, other contributory factors include the duration of diabetes, circulatory status, blood glucose levels, age, height, limited joint mobility and the high plantar pressures that are often present as a result of structural deformities in the foot.4-6 When these underlying factors are present, relatively minor traumatic incidents, such as ill fitting footwear or knocking a toe against a firm object, wind up instigating the causal chain that all too frequently leads to amputation.
Diabetic foot ulcers often become chronic and difficult to heal. Wound healing is a multifaceted event and any single intervention is likely to be of little value unless clinicians identify and address all the factors with the potential to delay wound healing.
Indeed, one needs to consider the factors that promote healing. These factors include glycemic control, appropriate management of tissue, whether surgical revascularization is indicated and the correction of defined biological abnormalities.7
In terms of appropriate wound care, one must debride the ulcer itself of all necrotic and callused tissue until the full extent of the ulceration is evident.8 Seemingly simple ulcers are often complicated by sinuses and tracking, and clinicians need to identify and treat these appropriately.
Understanding The Compliance Limitations Of Offloading
It has been suggested that trauma during ambulation may not only create a wound but also keep it in the chronic inflammatory phase. Perhaps the single most significant factor in promoting healing of such an ulceration is the reduction of the high pressure loading caused by limited joint mobility in an insensate foot.9 Rest, elevation and relief of pressure have been confirmed as the essential components of treatment. Accordingly, clinicians should emphasize these components at the very outset of treatment.10
Offloading strategies include the use of bed rest, walking aids and various types of casts and walkers. The most popular interventions are the use of casts and special walkers. Total contact casts are in the form of plaster of Paris or fiberglass cast material applied to the foot and leg. Such casts are not removable and rely on frequent and regular visits to specialist technicians for removal and reapplication of the cast.