(A) Physical therapy
1.Improve lower limb circulation
1.Massage treatment
From above the infected ulcer or gangrene site with appropriate force for centripetal pushing, 10-12min, 1-2 times a day. It helps the venous and lymphatic fluid reflux and the edema to subside.
2.Exercise therapy
Section 1: The patient lies down with the affected limb straight and elevated at 45°. Dorsal extension and plantar flexion of the toes 30 times, 1-2 times a day.
Section 2: The patient lies down with the affected limb straightened and elevated at 45°. Extend and flex the ankle joint 30 times, 1-2 times a day.
Section 3: The patient lies flat on his back with the affected side against the edge of the bed and the affected limb is straightened and elevated at 45° for 2-3 minutes, and then placed flat on the bed for 2-3 minutes. 1-2 times a day.
3.Positive and negative pressure treatment
The pressure is alternated between -6.8kpa-+13.4kpa, each phase is 30 seconds, each time for 1 hour, once a day.
Principle: The arterial perfusion of the lower extremity is very fast and adequate in the negative phase; the venous and lymphatic reflux is fast and adequate in the positive phase. Repeatedly, the blood circulation of the lower extremity can be passively and effectively enhanced.
There are infected wounds partly forbidden to apply pressure, otherwise there are generated pus, poison, bacteria into the blood circulation and cause sepsis or bacteraemia.
2, the treatment of infected ulcerated wounds and gangrene
1.Whirlpool bath
1-2 times a day for 30min each time.
Effects.
Firstly, remove the pus, blood, scabs and decaying tissue from the wound.
Secondly, it greatly reduces the number of bacteria on the trauma surface.
Thirdly, it has a reduced osmotic pressure effect on the superficial layer of the trauma, which is beneficial to the microcirculation of the trauma and to the control of infection.
Fourthly, it is conducive to the smooth operation of each nibbling way to clear the wound.
2.Ultra-short wave therapy: electrodes are placed opposite to the affected area without heat for 10-15 minutes, which can fight infection and promote ulcer healing.
3.Ultraviolet ray treatment: small dose of ultraviolet ray (1~2 level erythema amount) can promote fresh ulcer healing, and large dose of ultraviolet ray (3~4 level erythema amount) can remove infected necrotic tissue on the ulcer surface.
4, infrared treatment: warm heat local irradiation can promote fresh ulcers to accelerate healing, such as patients combined with limb sensory impairment, ischemia should be used with caution, such as the ulcer surface with purulent secretions is prohibited.
5.He-Ne laser therapy: He-Ne laser can stimulate vasodilation, promote the regeneration of epithelial cells and capillaries, reduce inflammatory exudation, strengthen tissue metabolism, promote the growth of granulation tissue, so as to achieve the effect of anti-infection, analgesia and accelerate the healing of ulcer surface. Generally use scattered focus irradiation, output power 25mW, spot diameter 75px, practical irradiation current 10mA, distance 25-1250px, irradiation time 15 minutes, irradiation should keep the beam and ulcer surface perpendicular, ulcer surface should be promptly dipped dry if there is exudate, daily irradiation once, 15 times for a course of treatment, course interval 1 week, irradiation finished with sterile gauze dressing cover ulcer surface.
6.Clearance
Adopt nibbling method. Clean up every 1-2 days, cut off the rotten and lifeless tissues. When there is granulation tissue formation on the trauma surface, the scabs around the trauma surface should be torn off as much as possible so that the cells of the skin growth layer around the trauma surface creep and crawl towards the center.
(II) Occupational therapy
Diabetic foot ulcer or amputation can affect the patient’s walking function and have a greater impact on the patient’s daily life activities. The role of occupational therapy is mainly to improve the patient’s walking function and enhance the patient’s ability to perform daily living.
Specific methods include ADL training, proper use and wearing of orthopedic appliances, crutches or wheelchair operation skills training, prosthetic foot walking training, patient-appropriate vocational training and appropriate environmental modification.
(C) Rehabilitation engineering
The use of rehabilitation engineering in diabetic foot starts with the use of special footwear to reduce the pressure on the foot.
For anterior foot injuries, devices that allow only the rear part of the foot to walk can be used to reduce the load, i.e. “half-shoes” or “heel-sandals”;
Full-contact or special brace boots can reduce the pressure on the ulcer by fitting the foot into a fixed full-contact model;
Patients with walking impairment can also use crutches or wheelchairs, and amputees can be fitted with prostheses to improve their walking function, depending on the situation.
(IV) Health education
A. Active control of diabetes mellitus and strict control of hyperglycemia;
B. Strictly control high blood lipid and all kinds of atherosclerosis leading to atherosclerosis;
C. Maintain foot hygiene. Wash your feet with warm water every day, but pay attention to avoid hot water burns;
D, shoes and socks should be clean, loose, soft, fit the foot, good ventilation.
E, should not walk barefoot. It is not advisable to wear flip-flops outside;
F, foot deformity, to see an orthopedic surgeon;
G. Be careful when trimming the callus with a razor blade, do not cut too deep and do not bleed, so as not to cause infection;
H. Be careful with the use of corneal cream, it is a corrosive drug, too deep corrosion may cause infection;
I, appropriate exercise, do not smoke;
J, have foot disease, ringworm should be timely treatment.