Courtesy Complete Foot and Ankle Care of North Texas
A diabetic foot ulcer is an open sore or wound that occurs in 15 percent of patients with diabetes and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, 6 percent will be hospitalized due to infection or other ulcer-related complication.
Diabetes is the leading cause of non-traumatic lower extremity amputations in the U.S., and approximately 14 to 24 percent of patients with diabetes who develop a foot ulcer will require an amputation. Foot ulceration precedes 85 percent of diabetes-related amputations.
Causes
Anyone who has diabetes can develop a foot ulcer. People who use insulin are at higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers.
Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation, and trauma, as well as duration of diabetes. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of ability to feel pain in the feet due to nerve damage caused by elevated blood glucose levels over time. Your podiatrist can test feet for neuropathy with a simple, painless tool called a monofilament.
Vascular disease can complicate a foot ulcer, reducing the body’s ability to heal and increasing the risk for an infection. Elevations in blood glucose can reduce the body’s ability to fight off a potential infection and also slow healing.
Symptoms
Because many people who develop foot ulcers have lost the ability to feel pain, pain is not a common symptom. The first thing you may notice is some drainage on your socks. Redness and swelling may also be associated with the ulceration and, if it has progressed, odor may be present.
Diagnosis and Treatment
Once an ulcer is noticed, seek podiatric medical care immediately. The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible.
For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.” You may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches.
We know that wounds and ulcers heal faster if they are kept covered and moist. The use of full-strength betadine, hydrogen peroxide, whirlpools, and soaking are not recommended, as these practices could lead to complications.
Wound management includes the use of dressings and topically-applied medications. Products range from normal saline to growth factors, ulcer dressings, and skin substitutes.
For a wound to heal there must be adequate circulation to the ulcerated area. Your podiatrist can determine circulation levels.
Tightly controlling blood glucose is important during the treatment of a diabetic foot ulcer. Working closely with a medical doctor or endocrinologist to control blood glucose will enhance healing and reduce the risk of complications.
Surgical Options: A majority of non-infected foot ulcers are treated without surgery; however, if this treatment method fails, surgical management may be appropriate. Examples of surgical care to remove pressure on the affected area include shaving or excision of bone(s) and the correction of various deformities, such as hammertoes, bunions, or bony “bumps.”
Prevention
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.
You are at high risk if you have or do the following:
• Neuropathy
• Poor circulation
• A foot deformity (e.g., bunion, hammer toe)
• Wear inappropriate shoes
• Uncontrolled blood sugar
• History of previous foot ulceration
Reducing smoking, drinking alcohol, high cholesterol, and elevated blood glucose are important in prevention and treatment of a diabetic foot ulcer. Wearing the appropriate shoes and socks will go a long way in reducing risks.
Learning how to check your feet is crucial so that you can find a potential problem. Inspect your feet every day. Each time you visit a health-care provider, remove your shoes and socks so your feet can be examined. Any problems that are discovered should be reported to your podiatrist as soon as possible.
If you’re experiencing foot or ankle problems, Complete Foot and Ankle Care invites you to make an appointment with us by calling 940-300-3054. www.completefootandanklecare.com
