What is a Diabetic Foot Ulcer?
A diabetic foot ulcer is an open sore or wound that most commonly occurs on the bottom of the foot in approximately 15 percent of patients with diabetes. Of those who develop a foot ulcer, six percent will be hospitalized due to infection or other ulcer-related complication.
Diabetes is the leading cause of nontraumatic lower extremity amputations in the United States , and approximately 14 to 24 percent of patients with diabetes who develop a foot ulcer have an amputation. However, studies have shown that the development of a foot ulcer is preventable.
How do Diabetic Foot Ulcers Form?
Ulcers form due to a combination of factors, such as lack of feeling in the foot ( neuropathy) , poor circulation (PAD), foot deformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of feeling in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain and one may not even be aware of the problem. Your podiatric physician can test feet for neuropathy with a simple and painless tool called a monofilament.
Poor circulation can complicate a foot ulcer, reducing the body’s ability to heal and increasing the risk for an infection, amputation and hospitalization.
How Should a Diabetic Foot Ulcer be Treated?
The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.
There are several key factors in the appropriate treatment of a diabetic foot ulcer:
- Prevention of infection.
- Taking the pressure off the area, called “off-loading.”
- Removing dead skin and tissue, called “debridement.”
- Applying medication or dressings to the ulcer.
- Managing blood glucose and other health problems.
Not all ulcers are infected; however if your podiatric physician diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.
There are several important factors to keep an ulcer from becoming infected:
- Keep blood glucose levels under tight control.
- Keep the ulcer clean and bandaged.
- Cleanse the wound daily, using a wound dressing or bandage.
- Do not walk barefoot.
For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.” Patients may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches. These devices will reduce the pressure at the ulcer site allowing for faster wound healing.
The science of wound care has made signifiacnt advance over the past ten years. Appropriate wound management includes the use of dressings and topically-applied medications. These range from normal saline to advanced products, such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.
For a wound to heal there must be adequate circulation to the ulcerated area. Your podiatrist can determine circulation levels with noninvasive tests.
How Can a Foot Ulcer be Prevented?
The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing a podiatrist on a regular basis, wearing proper fitting shoes and checking the status of your circulation. Your Podiatrist will determine if you are at high risk for developing a foot ulcer and implement strategies for prevention.
You are at high risk if you:
- have neuropathy,
- have poor circulation,
- have a foot deformity (i.e. bunion, hammer toe),
- wear inappropriate shoes,
- have uncontrolled blood sugar.
Diabetic Foot Ulcers