TALKS ABOUT DIABETIC
is a Diabetic Foot Ulcer?
diabetic foot ulcer is an open sore or wound that most com- monly 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.
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. Research, however,
has shown that the development of a foot ulcer is preventable.
who has diabetes can develop a foot ulcer. Native Americans, African
Americans, Hispanics and older men are more likely to develop ulcers.
People who use insulin are at a 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.
form due to a combination of factors, such as lack of feeling in the
foot, poor circulation, 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.
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 retard healing.
Once an ulcer is noticed, seek podi- atric medical care immediately. Foot ulcers in patients with diabetes should be treated for several reasons such as, reducing the risk of infection and amputation, improving function and quality of life, and reducing health care costs.
primary goal in the treatment of foot ulcers is to obtain healing as
soon as possible. The faster the healing,
are several key factors in the ap-propriate treatment of a diabetic foot
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.
are several important factors to keep an ulcer from becoming infected:
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 and irritation to the
ulcer area and help to speed the healing process.
science of wound care has advanced significantly over the past ten
years. The old thought of “let the air get at it” is now known to be
harmful to healing. We know that wounds and ulcers heal faster, with a
lower risk of infection, if they are kept covered and moist. The use of
full strength betadine, peroxide, whirlpools and soaking are not
recommended, as this could lead to further complications.
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.
a wound to heal there must be adequate circulation to the ulcerated
area. Your podiatrist can determine circulation levels with noninvasive
Tightly controlling blood glucose is of the utmost importance dur- ing the treatment of a diabetic foot ulcer. Working closely with a medical doctor or endocrinologist to accomplish this will enhance healing and reduce the risk of complications.
A majority of noninfected foot ulcers are treated without surgery; however, when this 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.”
Healing time depends on a variety of factors, such as wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and what is being applied to the wound. Healing may occur within weeks or require several months.
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. He or she can determine if you are at high risk for
developing a foot ulcer and implement strategies for prevention.
are at high risk if you:
additional risk factors, such as smoking, drinking alcohol, high
cholesterol, and elevated blood glucose are important in the prevention
and treatment of a diabetic foot ulcer. Wearing the appropriate shoes
and socks will go a long way in reducing risks. Your podiatric physician
can provide guidance in selecting the proper shoes.
how to check your feet is crucial in noticing a potential problem as
early as possible. Inspect your feet every day—especially between the
toes and the sole—for cuts, bruises, cracks, blisters, redness,
ulcers, and any sign of abnormality. 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, no matter how “simple” it may seem to you.
key to successful wound healing is regular podiatric medical care to
ensure the following “gold standard” of care:
old saying, “an ounce of prevention is worth a pound of cure” was
never as true as it is when preventing a diabetic foot ulcer.