Definition
Diabetic foot ulcers are sores that occur on the feet of people with type 1 and type 2 diabetes . Up to 25% of people with diabetes develop foot problems. Diabetic foot ulcers usually occur on the bottom of the foot. They precede over 80% of leg amputations in the United States. However, the sooner diabetic foot ulcers are treated, the better the outcome.
Foot Ulcer
Causes
Diabetes can damage the nerves of the legs and feet so that you may not feel a blister or sore when it begins to appear. If undetected, the sore may become larger and infected. This may lead to an amputation of a toe, a foot, or even a leg.
Risk Factors
A risk factor is something that increases your chance of getting a disease or conditon.
The following factors increase your chance of developing diabetic foot ulcers. If you have diabetes and any of these risk factors, tell your doctor:
• Neuropathy (decreased feeling in your feet)
• Peripheral vascular disease (poor circulation in your legs)
• Improperly fitted shoes
• A foot deformity
• Retinopathy (decreased vision for inspecting your feet daily)
• A history of smoking
Symptoms
If you experience any of these symptoms, do not assume it is due to diabetic foot ulcers. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.
• Sores or blisters on the foot or lower leg
• Fever, skin redness or swelling, or other signs of infection
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. Your primary doctor may refer you to a foot specialist or podiatrist.
Tests may include the following:
• Wound culture to determine if an infection is present
• X-rays to determine if there is evidence of infection in the bones ( osteomyelitis )
• CT scan or MRI to evaluate a suspected pocket of pus called an abscess
• Doppler studies to assess for adequate blood flow to feet, which is necessary for healing
• Blood glucose and glycohemoglobin test called HbA1C test
• Complete blood count to determine if there is evidence of infection. A high white blood cell count may mean that there is an infection.
Treatment
Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Medication
Regranex gel is a medication approved by the Food and Drug Administration (FDA) for the treatment of diabetic foot ulcer. It has been shown to speed wound healing.
No Weight-bearing
Keeping pressure off the foot ulcer promotes healing. Sometimes special casts or boots are placed on the foot to “off-load” pressure from the ulcer.
Wound Care
Cleanse the wound regularly and change the dressings often to prevent infection.
Antibiotics
Antibiotics are often used—even if an infection is not clearly present—to prevent an infection. Usually they are administered for 4-6 weeks.
Blood Sugar Control
Infected ulcers are likely to cause high blood sugar levels. High blood sugar levels lower immune response and prevent wound healing. Therefore, improved blood sugar control—with adjustments in diet or medications—aids in fighting infections and healing wounds. Sometimes insulin shots are needed in the short-term to achieve optimal blood sugar control.
Skin Graft
Bioengineered skin graft or human skin graft can be used to treat diabetic foot ulcers which fail to heal with conventional treatments. Skin grafts have been shown to speed up the healing process.
Surgery
The removal of dead tissue around the wound, or debridement, is often needed to clean the wound and promote healing. Bypass surgery to improve blood flow within the arteries of the legs may help with wound healing and spare amputations. As a last resort, amputation surgery may be needed to stop the spread of infection to the rest of the body.
Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy appears to help reduce major amputations. People with nonhealing wounds are placed in a chamber. Pure oxygen is pumped into the chamber, which saturates the blood with oxygen. This oxygen-rich blood helps form new blood vessels, which helps the wound heal.
Prevention
To help reduce your chances of getting diabetic foot ulcers, take the following steps:
• Cleanse your feet daily and dry them thoroughly between the toes before putting shoes and socks on. Do not wear garters and tight stockings around the legs.
• You may want to use petroleum jelly or an unscented lotion to moisturize dry, leathery feet. Do not put lotion between the toes, since the extra moisture may attract bacteria.
• After cleansing your feet, inspect them daily for sores that you may not be able to feel. Use a mirror or the assistance of another person to see parts of the feet you may not usually be able to see.
• Your primary doctor should look at your feet and test the feeling in them at least once a year at your regular visit. If you find a sore at any time, make an appointment to see your doctor immediately. You may be referred to a foot specialist or podiatrist for treatment of your foot ulcer.
• People with diabetes may have toenails that are brittle and difficult to cut without causing ingrown toenails. You may also want to have a foot specialist or podiatrist trim your toenails regularly.
• Buy properly fitted shoes. If you have Medicare coverage, once per calendar year Medicare (Part B) will pay 80% of the cost of a pair of properly fitted, custom-made shoes with inserts for people with diabetes. Costs may vary by state. The doctor who treats your diabetes must verify that you have a need for these shoes. Then you will need a prescription for these shoes from a podiatrist.
• Avoid smoking.
• Exercise daily, with the approval of your doctor, to improve blood flow and blood sugar levels.
• Calluses can increase the pressure in the foot leading to foot ulcers. Have your podiatrist cut any callus once you detect it. This could reduce the risk of coming down with a foot ulcer in the future.
